Clinicopathological Characteristics of Mucinous and Non-mucinous Adenocarcinoma of the Colon and Rectum.

Colorectal carcinoma is the most common cancer of the gastrointestinal tract. More than 95.0% of the cancer is adenocarcinoma. Mucinous adenocarcinomas account for about 10.0% of all colorectal cancers. The expression of mucin themselves may play a role in the ability of tumors cells to escape the effect of systemic therapy and the process of tumor progression, invasion, survival and protection against the host immune response. The mucin lakes may also be a physiological barrier for the delivery of targeted therapy to the tumors cells. The aim of this study was to evaluate and compare the morphologic and histologic prognostic factors of mucinous and non-mucinous adenocarcinoma of the colon and rectum. In this descriptive cross-sectional type of observational study a total of 98 samples with colorectal adenocarcinoma were evaluated on the basis of presence or absence of the mucin from 2017 and 2018. The study was conducted in paraffin-embedded tumor tissue whose slides were stained using the hematoxylin-eosin technique. Mucin was evaluated by Periodic acid schiff and Diastase periodic acid schiff stain. Totally, 27 of 98 patients with colorectal adenocarcinoma (27.6%) had mucinous histologic subtype. Statistical significant results found in this research are as follows: Mucinous subtype tended to have present with moderate anaemia, history of low vegetable diet and larger tumor size, proximal colon involvement, infiltrative morphology and higher stage II compared to non-mucinous histologic subtype. Mucinous histologic subtype was associated with some adverse pathologic features in patients with colorectal cancer.

Assessment of Number and Distribution of Mast Cell in Oral Squamous Cell Carcinoma in Biopsy Specimen and Its Correlation with Histological Grading.

Oral cancer is a commonly occurring one worldwide. More than 90% of all oral cancers are squamous cell carcinoma (SCC). The molecular biological markers of oral SCC have been extensively studied to aid in prevention and prognosis. However, no marker has been universally accepted so far. Mast cells are important component of cancer stromal interaction. Their early recruitment in tumor microenvironment and multifarious function make them a burning topic of interest in the field of research. So mast cell may act as a new target for the adjuvant treatment of oral SCC. Therefore, the aim of the study was to compare the number and distribution of mast cell between different grades of oral SCC. In this cross sectional study the sample size was 100. After routine tissue processing and staining with Hematoxylin & Eosin (H/E) stains, slides of all cases were grouped as- well, moderate and poorly differentiated invasive squamous cell carcinoma according to Anneroth's grading system. Identification of mast cell was done by Toluidine blue stain. Distribution of mast cells was observed and number of mast cells was counted. The data was tabulated and statistical analysis was performed. Out of 100 cases, 66% patients belonged to Grade I, 28% Grade II and 6% Grade III. The mean±SD number of mast cells was 3.28±1.21, 1.59±0.58 and 0.44±0.17 in Grade I, Grade II and Grade III SCC, respectively. The p value was found to be highly significant (p<0.001). An inverse significant Pearson's correlation was found between number of mast cells and grades of oral SCC. The number of mast cell was slightly increased in oral SCC cases than normal. The number of mast cells also had an inverse association with histologic grade. So, in this observation mast cell is a good cellular indicator of tumor grade.

Comparative Study of Cytology and Histopathology of Cervical Lesion in VIA Positive Patients and Its Correlation with High Risk Human Papilloma Virus.

Cervical cancer is the second most frequent type of cancer and leading cause of mortality among women worldwide. The present study was undertaken to assess precancerous and cancerous cervical lesion by cytology as well as HPV DNA identification and their comparison with histopathology in VIA positive cases. This descriptive, cross-sectional type of observational study was carried out in the Department of Pathology, Mymensingh Medical College in collaboration with the Department of Gynecology and Obstetrics, Mymensingh Medical College Hospital and Department of Microbiology and Hygiene in Bangladesh Agriculture University for HPV DNA detection from July 2012 to June 2013. Study was carried out among 160 VIA positive patients and selected by non-random judgment sampling from the colposcopy clinic. Out of 160 cases, only 40(25.00%) were found HPV DNA positive, while the rest 120(75.00%) cases were negative. Among positive cases 77.50% were cancerous cases and 22.50% were precancerous cases. It was further revealed that in cancerous cases, 86.11% were HPV DNA positive. PCR showed low sensitivity, probably due to sampling error and inclusion of all cases (chronic cervicitis, precancerous and cancerous lesion). The statistical value of accuracy, sensitivity and specificity of Pap smear cytology, HPV DNA test and histopathology yielded some important directives. The sensitivity values of Pap smear cytology and HPV DNA were found 87.50% and 88.89% respectively. Thus Pap smear test showed almost equal sensitivity to DNA test. The accuracy of the Pap smears and HPV DNA in this study was 88.13% and 96.88% respectively. The accuracy of Pap smears is lower than HPV DNA tests. The present study show significant relationship between cytological with HPV DNA test and histopathological diagnosis. But cytology and HPV DNA testing are not suitable as a single test. In conclusion, it can be stated that combination cytology (Pap smear), histopathology and new technologies such as HPV DNA typing would ultimately be more useful.

Histological and Cytological Correlation of Cervical Cancer and Precancerous Lesions in a Tertiary Hospital in Bangladesh.

Over 500,000 new cases of cervical cancer are diagnosed each year in the world, resulting in 250000 deaths. Prevalence of HPV-related cervical carcinoma in Bangladesh is highest among SAARC countries. In Bangladesh very few studies have been published on establishing the correlation between histological and cytological findings on cervical cancer and precancerous lesions. This descriptive cross-sectional study was performed to find out the correlation between histological & cytological findings of cervical cancer and precancerous lesions. In the present study, cervical smears were collected from the selected patients attending the colposcopy clinic of BSMMU from July 2011 to April 2013. Biopsy was done on colposcopically positive cases and histopathological reports were obtained. Thus 99 histologically proven cases of cervical cancer and precancerous lesion were selected. Pap smear was carried out on these 99 samples after histopathological examination. Among the 60 CIN-1 cases in histology, 18(30%) cases were diagnosed positive by Pap smear; out of 20 histologically diagnosed cases of CIN-II, only 12(60%) cases were correctly diagnosed by cytology. But in case of invasive squamous cell carcinoma 18 out of 19 were correctly diagnosed by Pap smear reaching a concordance rate of 94.74%. Overall the relation reached statistical significance (p<0.05). Larger community based studies are required in this respect to find a consistent correlation between hr-HPV load and cervical cancer and precancerous lesions.

Spectrum of Salivary Gland Lesions in a Tertiary Level Hospital.

Salivary gland tumors are relatively infrequent and account for less than 2% of all human tumors. This study was conducted to see the prevalence of patterns of non neoplastic and neoplastic lesions of salivary glands in greater Mymensingh. It was a retrospective study carried out in the department of Pathology, Community Based Medical College Bangladesh from January 2010 to December 2012. Heamatoxylin and eosin stained sections were studied in all cases. Total 98 cases of salivary gland lesions were retrieved and evaluated. Out of them 55 cases were female and 43 were male. Mean age of the cases were 42 years. Among the salivary gland lesions non-neoplastic lesions 24.48% and neoplastic lesions 75.51%. Among neoplastic lesions benign tumor comprises 91.89% and malignant tumor comprises 8.10%.

Soft tissue tumours and tumour like lesions - a demographic and clinicopathologic study of 461 cases from different regions of Bangladesh.

Soft tissue tumours and tumour like lesions are relatively rare. They pose diagnostic difficulty due to wide morphological variation as well as overlapping clinical and pathological features. The relative frequency of soft tissue tumours varies throughout world. This study was undertaken to find out the distribution of soft tissue tumours and tumour like lesions in Babgladesh. Four hundred and sixty one cases of soft tissue tumour and tumour like lesions were studied to see the demographic and clinicopathologic pattern. Benign 320(69.4%) and malignant 141(30.6%) cases were recorded. Of all cases mean age was 31.07±16.87 years with M:F ratio of 1:0.71 (p=0.001). Upper extremity was the most common site. Majority of the benign cases (84.1%) were superficially located whereas majority of malignant cases (89.2%) were deep seated (p=0.001). Lipoma and fibrosarcoma was the most common benign and malignant tumour respectively observed in this study. In childhood group, rhabdomyosarcona was the commonest one. The distribution pattern of soft tissue tumours in Bangladeshi population is roughly similar to that described in other countries with few exceptions.

Endometrial stromal nodule - a case report.

Among the endometrial tumour endometrial stromal nodule are very rare. It is one of the form of endometrial stromal tumour. There are no definite presurgical diagnosis and diagnosis in most instances by microscopy. Hysterectomy is the treatment of choice to evaluate the tumour margin to differentiate it from stromal sarcoma. We present a case of 40 years woman, ultrasonographically diagnosed as leiomyoma and ovarian cystadenoma, underwent a total abdominal hysterectomy with one sided salpingo-oophorectomy. Microscopic examination show an endometrial stromal nodule and serous cystadenoma of the ovary. Though it is a benign tumour margin should be carefully examined to differentiate from stromal sarcoma, whose treatment and prognosis is totally different.

Nasal glioma in a six month old girl.

Congenital midline frontonasal swellings are rare condition and nasal glioma accounts for 5% of these abnormality. Nasal gliomas are benign tumours results from embryonic developmental error. Although it is a rare tumour but clinically it has some differential diagnoses. Most common are dermoid tumour, nasal glioma and nasal encephalocele. About 15-20% cases nasal glioma have a fibrous stalk that connecting to the central nervous system. Multidisciplinary approach is needed for proper diagnosis and to prevent life threatening intracranial complication. We present a case of nasal glioma in a 6 months old girl presented with a congenital swelling on the left lateral side of the nose with complaints of watering from the eye of same side.

Color Doppler sonography and resistivity index in the differential diagnosis of hepatic neoplasm.

The purpose of this study was to determine the usefulness of color doppler sonography and resistivity index (RI) in differentiating liver tumors. The study was carried out in the Department of Radiology and Imaging, Mymensingh Medical College Hospital, and Institute of Nuclear Medicine and Allied Sciences (INMAS), Mymensingh, Bangladesh, during the period of July 2009 to June 2011. Total 50 consecutive cases were studied. Among them 27 were hepatocellular carcinomas, 19 were metastatic tumors, 03 were hemangiomas and 01 was hepatic adenoma. Doppler sonographic findings were then correlated, case by case, with final diagnosis- either pathologically by USG guided Fine-needle aspiration or by other imaging modalities (e.g., CT scan and RBC liver scan for hepatic hemangioma). The RI value of hepatocellular carcinoma was 0.69±0.096 and in metastatic tumors 0.73±0.079. The results showed no significant difference between the RI of hepatocellular carcinomas and metastatic liver tumors but it was significantly higher than benign lesions (p<0.05). RI of hemangiomas was 0.49±0.64 and in one hepatic adenoma was 0.65. When RI was <0.6 for benign liver tumors and ≥0.6 for malignant tumors we calculated a sensitivity of 89.14%, specificity of 66.7%, accuracy of 85.71% positive predictive value of 97.62% and negative predictive value of 28.57% in differentiating benign and malignant tumors. Thirty four of 46(73.9%) malignant lesions had intratumoral flow and 25% of benign lesions also showed intratumoral flow. The difference of intratumoral flow between malignant and benign lesions was significant (p<0.01). Two of 4 benign lesions (50%) had peritumoral vascularity where 6% of the malignant tumors showed peritumoral vascularity. In conclusion, combined studies of the type of intra-and peri-tumoral flow signals in CDFI and the parameter of RI would be more helpful in the differential diagnosis of benign and malignant liver tumors.

Urinary tuberculosis presented as isolated bladder lesion - a case report.

Extra-pulmonary Tuberculosis (EPTB) may affect all organs of the body with varied presentations. Genitourinary tuberculosis (GUTB) carries importance for its morbidity, though it is an uncommon form of TB. A widow of 45 years was admitted with several episodes of painless haematuria and recently developed urinary incontinence. Diagnosis of urinary bladder tuberculosis was made only by histopathology from bladder lesion with supportive evidence of few nonspecific constitutional symptoms and positive family history of pulmonary tuberculosis (PTB) and persistent sterile pyuria. Upper urinary tract involvement was not found. Category 1 anti-TB treatment was started. With this treatment recovery of the patient is satisfactory and symptoms are disappearing except for the incontinence. Urinary tuberculosis should be ruled out in a case of painless haematuria, repeated sterile pyuria.

HIV-associated nephropathy (HIVAN): a short review of different authors.

Human immunodeficiency virus associated nephropathy (HIVAN) is clinically and morphologically a distinctive type of renal parenchymal disorder. It is presented in an HIV-seropositive individual by proteinuria and progressive renal insufficiency, usually without oedema or hypertension. Renal biopsy most commonly reveals a collapsing form of focal segmental glomerulosclerosis with marked proliferation of glomerular podocytes and tubular microcystic dilatation. These characteristic changes are attributed to incorporation of DNA and mRNA of human immunodeficiency virus type 1 into the renal parenchymal cells. Newly introduced highly active anti-retroviral therapy (HAART) has significantly reduced the incidence of HIVAN in the recent years. The HAART has been found to retard and revert the progression of renal insufficiency towards end-stage renal disease, and to increase survival of the patient. Therefore a renal biopsy should be performed in all suspected patients for definitive diagnosis of HIVAN and better patient management.

Antibiotic prophylaxis is unnecessary in clean surgery.

A significant number of paediatric surgical patients undergone clean surgical procedures. Most of the paediatric surgeon use perioperative prophylactic antibiotic in this clean procedure because of undue fear of infection in their mind. The objective of this study is to evaluate whether the use of perioperative prophylactic antibiotics have an effect to prevent post operative wound infection in clean operation in paediatric surgical patients. This study was conducted in the paediatric surgery department of Bangabandhu Sheikh Mujib Medical University and some private clinics of Dhaka city from January 2009 to December 2009. Two hundred patients who were undergone clean elective surgical procedure on day case basis were included in this study. They were divided into two equal groups (Group A and Group B). The patients of Group A were given intransverse Cephradine 30 minutes before incision and then oral Cephradine was advised postoperatively for 7 days. The patients of Group B were not given any perioperative antibiotic. All the patients of both groups were advised to come on 3rd, 6th and 10th postoperative day for examination of wound. In Group A (With chemo prophylaxis), five patients (5%) developed postoperative wound infection and in Group B (without chemo prophylaxis), three patients (3%) developed postoperative wound infection. Thus the rate of postoperative wound infection is slightly more in patients with chemo prophylaxis but it was not statistically significant by chi-square test. Based on the result of this study, it may be concluded that the antibiotic prophylaxis is not necessary in clean surgery in paediatric age group.

Comparison between fine needle aspiration cytology with histopathology to validate accurate diagnosis of palpable breast lump.

A prospective study of 114 patients was conducted to assess the clinical correlation and diagnostic accuracy between FNAC and histopathology of breast lumps. Correlation was found out between clinical suspicion with FNAC and histopathological findings. The results obtained from histopathology were matched with those of FNAC and a correlation was sought based on statistical tests. Statistical analysis was performed on data and sensitivity and specificity with positive and negative predictive value were obtained. Although FNAC was performed on 114 patients presented with breast lump but histopathology available for 75 cases. Fifteen cases were found to be malignant on both FNAC and histopathology. For malignant lesion the sensitivity of the study was 96% and the specificity for malignant lesions was 100%. The positive predictive value was 100% and the negative predictive value was 95.12%. It was concluded that FNAC is a cheap, rapid, reliable and accurate test of diagnosing a palpable breast lump. It provides a good histological correlation, thus avoiding undue surgical biopsy prior to definitive surgery for malignancy.

Invasive ductal carcinoma in a young male breast.

Carcinoma arising in the male breast is a rare occurrence. The risk of male breast cancer increases with age, and the median age of diagnosis for men is 10 years later than that for females (67 to 71 years). Because of the absence of lobules in the normal male breast, lobular carcinoma cases are seen infrequently. All of the microscopic types identified in the female breast have been encountered in male but the most frequent is invasive ductal carcinoma and less frequent is invasive lobular carcinoma. We present the case of a 20 years old man presenting with a left breast lump. After left mastectomy with level 2 axillary clearance, histopathological examination revealed infiltrating ductal carcinoma. Our case represents ductal carcinoma in a proven genotypic young male patient showing no exogenous or endogenous estrogens exposure.

Gaucher disease.

A 14 months old boy of consanguineous parent presented with hepatosplenomegaly with delayed mile stones of development. He is till unable to walk. He was moderately anemic. Moderately wasted and stunted. Neurological examination was normal except subnormal intelligence. This subnormal intelligence and delayed milestone possibly may be due to secondary effect of growth retardation. Musculo-skeletal system examination revealed no abnormality. Diagnosis was supported by typical bone involvement in X-ray film (Thin cortex in Limb bone) and Gaucher cell in the splenic aspiration. There are three sub-types Type I: Non neuropathic form. Type II: Acute neuropathic form. Type III: Chronic neuropathic form. However, some cases do not fit precisely into one of these categories. All forms of Gaucher disease are autosomal recessively inherited. So, this patient more or less correlates with Gaucher disease type I. Treatment option for type I and III include medicine and enzyme replacement therapy, which is usually very effective.

Thoracic actinomycosis.

Thoracic actinomycosis represents about one-fourth of all cases of the disease. Isolated pleural effusion due to Actinomycosis is rare. We report a case of right sided pleural effusion with discharging sinus in the right anterior chest wall. Actinomycosis was suspected and confirmed by microscopic identification of "sulfur granules" in the discharge of the sinus tract and also identification of gram-positive filamentous bacteria in the specimen of discharging sinus. The patient improved clinically and radiologically after treatment with intravenous penicillin G followed by oral penicillin and aspiration of pleural fluid.

Ultrasonography and missed threads of IUDs.

PIP: Ultrasonography was performed in 26 patients with missed IUD threads. It was accurate in 89% of the cases, and IUDs in utero were/easily identified. However, in cases of extrauterine devices, ultrasonography showed only a empty uterine cavity; it failed distinguish between an expelled device and one that had perforated the uterus. In the case of pregnancy on top of the device, ultrasound was the best diagnostic modality for detecting the pregnancy and its duration.^ieng