Background: Gestational trophoblastic disease is a group of benign and malignant disorders defined by abnormal trophoblastic proliferation, of which hydatidiform mole is the most common, characterized by hydropic swelling of placental villi and trophoblastic hyperplasia. It is imperative to further classify hydatidiform mole into complete mole and partial mole, as complete mole is associated with an increased risk of gestational trophoblastic neoplasia. Materials and Methods: This was a cross-sectional study carried out in the Department of Pathology, SGRRIM&HS, Dehradun. 51 clinically diagnosed cases of molar pregnancies (24 complete mole, 1 partial mole, 1 Hydatidiform mole-NOS and 24 non-molar products of conception were included in the study. Histomorphological features and the expression of IHC p57Kip2 (57P06) in cytotrophoblasts and villous stromal cells were studied. Results: Histomorphological assessment of the 51 cases showed 24/51 (47%) cases of complete mole, 1/51 (2%) case of partial mole, 2/ 51 (3.9%) cases with ambiguous histology diagnosed as Hydatidiform mole-NOS, and 24/51 (47.1%) cases of non-molar products of conception. The majority of the patients [36/51 (70.6%)] were in the 21-30 years age group. Expression of p57Kip2 was found to be corroborating with histomorphological diagnosis in 48/51 (94.1%) cases, diagnostic in 2/51 (3.92 %) of cases, and non-contributory in 1/51 (1.96%) cases. Conclusions: The study confirms that negative p57 IHC expression may reliably identify complete mole. However, immunohistochemistry has a limited role in discriminating partial mole from hydrops abortus and is also inconclusive in cases with discordant expression.
Background: Prostate cancer is the most frequently diagnosed cancer among men, with the highest incidence seen in western countries. Prostate-specific antigen (PSA) is widely used as a screening tool for the detection of prostate cancer. Gleason grading system is the most commonly used pathological grading system for prostate cancer. This system is also a powerful prognostic factor and helps in determining clinical outcome. Materials and Methods: A retrospective cross-sectional study was done in the Department of Pathology, Tribhuvan University Teaching Hospital from January 2023 to June 2024. A total of 56 histopathologically and/or immunohistochemically confirmed cases of prostate adenocarcinoma with documented serum PSA level, Gleason score and Grade were included in the study. Serum PSA level was compared with Gleason score and Gleason grade. Correlation was done using Spearman’s rank correlation coefficient. P-value of ≤0.05 was considered to be statistically significant. Results: The mean age of the patients was 70.9 years with a mean serum PSA of 55.6 ng/ml. 63% of the patients had serum PSA level above 20 ng/ml. The most common Gleason score was 9. Gleason grade 5 was the most common Gleason grade. Statistically significant correlation of serum PSA with Gleason score and Grade was established with p-value <0.05. Conclusions: This study highlights that prostatic acinar adenocarcinoma predominantly affects older males. A strong positive correlation was observed between higher serum PSA levels and advanced Gleason scores and Gleason grades. The findings underscores the importance of PSA monitoring in high-risk groups.
Intrathyroidal parathyroid carcinoma is an exceptionally rare and often underrecognized malignancy arising from the parathyroid glands located ectopically within the thyroid gland, usually posing a diagnostic and therapeutic challenge due to its overlapping clinical and pathological features with benign parathyroid adenomas, hyperplasia, and other thyroid neoplasms. Despite advancements in diagnostic imaging and histopathological techniques, the incidence of intrathyroidal parathyroid carcinoma remains low, and much of the current knowledge is based on case reports and small series, highlighting the need for a consolidated review of its clinical course, diagnostic criteria, and management strategies. We report a case of a 60-year-old female presenting with midline neck swelling, which was diagnosed as intrathyroidal parathyroid carcinoma based on histopathology and immunohistochemistry, along with a detailed review emphasizing its clinical features, diagnostic approaches, and management strategies, while identifying areas for future research to elucidate this enigmatic malignancy better.
Background: Lichen planus and variants are common inflammatory dermatoses characterized primarily by lichenoid and vacuolar interface dermatitis involving the dermoepidermal junction of skin. Variants of lichen planus require histopathological evaluation to differentiate from other skin disorders due to overlapping clinical features and for accurate diagnosis. This study was undertaken to evaluate the histopathology of lichen planus variants and compare them in relation to age, sex, and anatomical site. Materials and Methods: This is a one-year prospective cross-sectional study done at the Department of Pathology in a tertiary care center and includes 44 cases of skin biopsies with histological features of lichen planus variants. Following standard protocol of tissue processing, H&E sections were examined by pathologists. Data entry and analysis were done using SPSS version 24. Results: Forty-four cases of skin lesions were diagnosed as lichen planus variants. The most common age of presentation was 21-40 years. The male-to-female ratio was 1:1.4. Common lichen planus variants were cutaneous lichen planus and oral lichen planus, followed by erythema dyschromicum perstans and lichen planopilaris. Lichen planus variants commonly involve the oral cavity, scalp, upper extremity, and trunk. The most consistent histopathological findings of lichen planus variants were basal layer vacuolation and band-like dense infiltration of the dermoepidermal junction. Conclusions: Lichen planus variants occurred in various age groups involving wide anatomical regions. Histopathological evaluation helps differentiate many skin disorders that have similar clinical presentation.
Background: Sarcomatoid carcinoma is a rare and aggressive variant of squamous cell carcinoma, accounting for 3% of all squamous cell carcinomas in the head and neck region, characterized by dysplastic surface squamous epithelium and an invasive spindle cell component. Materials and Methods: The study was conducted over six years (2017-2022) at the Gujarat Cancer and Research Institute, and a total of 117 cases of sarcomatoid carcinoma in the head and neck region were included, comprising resected specimens, biopsies, and cases reviewed from external institutions. Results: The median age at presentation was 49 years, with predominance in males (male: female 3.5:1). The most common sites were the buccal mucosa (44.4%), tongue (20.5%), and larynx (10.2%), typically presenting as proliferative or ulceroproliferative lesions with a polypoidal appearance. Immunohistochemistry, performed in 86 cases, revealed immunoreactivity to epithelial markers (EMA, p40, p63, CK5/6, AE1/AE3) in the majority of cases. In the resected specimen, over half of the patients (53.3%) presented with early T-stage disease (T1: 15.6%, T2: 37.8%), and 60% had no lymph node involvement (N0). Various treatment modalities were employed, including primary surgical resection (20.8%), neoadjuvant chemotherapy followed by surgery, and palliative care. The two-year survival rate was 43.8%, with recurrence observed in seven patients and one case of distant metastasis to the lung during the follow-up period. Conclusions: Sarcomatoid carcinoma of the head and neck is a rare but aggressive variant of squamous cell carcinoma that requires careful histopathological and immunohistochemical evaluation for accurate diagnosis due to its resemblance to other spindle cell tumors. Early-stage detection and timely intervention are crucial for improving patient outcomes. Despite diverse treatment approaches, the prognosis remains guarded, underscoring the need for heightened clinical awareness and further research to optimize management strategies.
Background: Cervical cancer is a significant health concern in India, and early detection is crucial. This study aimed to evaluate the prevalence and genotype of human papillomavirus in abnormal pap smears and correlate findings with histopathology. Methods and Materials: A one-year prospective study was done at Santosh Medical College, screening 3194 cases. HPV testing was performed on all patients, and biopsies were taken from those with abnormal epithelial lesions. The study includes sexually active women or women presenting with complaints such as abdominal pain, abnormal vaginal discharge or bleeding, or other vaginal sensations. It excludes unsatisfactory smears, unmarried females, pregnant women, lactating women, and diagnosed or treated cases of cervical carcinoma. Conclusions: This study suggests that pap and HPV co-testing from the initial visit can be cost-effective and reduce the need for follow-up appointments.
Background: Lymphomas are a group of heterogeneous lymphoproliferative malignancies with a distinctive behavior and treatment responses. Immunohistochemistry guides the accurate subtyping, diagnosis, and prognostication of lymphomas. The objective of this study was to observe subtypes of lymphoma and their distribution and frequency by age and gender. Materials and Methods: A two-year retrospective study (2020-2022) was conducted in the Department of Pathology, Vydehi Institute of Medical Sciences and Research Centre, India. Cases were subcategorized using panels of Immunohistochemistry. Results: Of 100 lymphoma cases, 73 were Non-Hodgkin lymphoma and 27 Hodgkin lymphoma. Males outnumbered females in both groups. Among NHL, Diffuse Large B-Cell Lymphoma-Not Otherwise Specified comprised 56%, with 29% being anaplastic variant, followed by small lymphocytic lymphoma. In Hodgkin Lymphoma, 25 cases were Classical Hodgkin Lymphoma, and 2 were Nodular Lymphocyte Predominant Hodgkin Lymphoma. Nodal involvement was more frequent, 73.6% in Non-Hodgkin Lymphoma and 85.1% in Hodgkin Lymphoma, with the cervical lymph node most commonly affected. Extranodal disease accounted for 27.3% of Non-Hodgkin Lymphoma and 14.8% of Hodgkin Lymphoma. Conclusions: Non-Hodgkin Lymphomas predominated over Hodgkin Lymphoma, with Diffuse large B-cell Lymphoma-NOS being the most common subtype. Immunohistochemistry remains essential for precise lymphoma subclassification, ensuring accurate diagnosis.
Background: Acute respiratory infections of viral and bacterial origin pose serious problems owing to their great prevalence, with associated high morbidity and mortality. In South Asia, acute respiratory acute respiratory infections cause about 15% of all pediatric deaths. Although infection rates are reported annually, there is limited information available regarding circulating respiratory pathogens. The aim was to determine the etiological agents of these respiratory diseases using multiplex molecular tests aiming to enhance knowledge on the circulation of viruses that causes acute respiratory infections in Nepal. Materials and Methods: This was a laboratory based retrospective cross-sectional study conducted from December 2020 to March 2021 on archived samples at National Influenza Center, Nepal, among children ≤2 years, who gave sample for influenza testing by the Dolphin system. Results: Of the 80 samples, 46 were positive. The most common was Respiratory Syncytial Virus A/B:13, followed by Adenovirus:12, Influenza A: 9, M. Pneumonia:4, ParainfluenzaVirus-3:4, Human Metapneumovirus Virus A/B, Human parechovirus, Rhinovirus, Influenza B :3, Para Influenza virus 4, Para Influenza Virus 2, Para Influenza virus 1 & Coronavirus 43:1. Also our result showed coinfectionin 11 samples of total tested samples. Conclusions: With a limited sample size, this study shows evidence of different pathogens that cause acute respiratory infection thus suggesting the need for community surveillance to enhance public health efforts and scientific understanding of respiratory infection for appropriate prevention, treatment & management strategies through strengthening molecular diagnostic methods which provide a rapid, sensitive and specific approach to improve the etiological diagnosis of infection.
Primary bone neoplasms are an uncommon group of neoplasms that include benign to malignant and locally aggressive or rarely metastasizing types. Giant cell tumor is a very rare tumor of the skull, with few of those reported cases arising from the sphenoid and temporal bone. Exact localisation is essential in the formulation of differential diagnosis between the diverse pathologies that affect this region. Herein, we discuss a case of Giant cell tumor in the sellar region.
Background: Thyroid dysfunction is a common endocrine abnormality globally. In Nepal, socio-environmental factors like iodine deficiency, dietary habits, and limited access to healthcare have exacerbated its prevalence. It is the altered serum thyroid stimulating hormone level with normal or altered thyroid hormones (free tri-iodothyronine and free thyroxine). The present study aimed to find the prevalence of thyroid dysfunction among individuals visiting a diagnostic center in Lalitpur, Nepal. Materials and Methods: This was a descriptive cross-sectional study conducted at the Genesis Diagnostic and Clinic in Lalitpur, Nepal, between July 1, 2022, to December 30, 2024. Ethical clearance was granted by the Ethical Review Board (Reference number: 1384). Patients who had undergone thyroid function tests, like assessments of free tri-iodothyronine, free thyroxine and thyroid-stimulating hormone, were enrolled. Enumeration sampling was done. SPSS version 22 was used for data analysis. Results: Out of 520 patients who underwent thyroid function test, thyroid dysfunction was seen in 118 (22.69%) patients. Among them, 93 (17.88%) had subclinical hypothyroidism, 13 (2.50%) had subclinical hyperthyroidism, six (1.20%) had hypothyroidism, and six (1.20%) had hyperthyroidism. There were 47 (39.84%) males and 71 (60.16%) females with thyroid dysfunction. The male-to-female ratio was 1:1.51. The age range was 20 to 90 years with a mean age of 44.53 ± 14.61 years. The maximum number of thyroid dysfunction cases occurred in the 30-39 years age group. Conclusion: The prevalence of thyroid dysfunction is still higher in our study population and is similar to studies done in similar settings. Subclinical hypothyroidism was the most common thyroid dysfunction with female predominance.
Background: Cervical cancer ranks as the fourth most common cancer in women worldwide. Accurate histologic interpretation of cervical intraepithelial neoplasia (CIN) is often challenging due to significant interobserver variability. Immunomarkers such as p16/INK4a and Ki-67 have emerged as valuable tools in detecting high-risk HPV-associated dysplasia, and minimizing diagnostics inconsistencies. Materials and Methods: A prospective cross-sectional study was carried out between June 16, 2019, to June 14, 2020, at Department of Pathology, Tribhuvan University Teaching Hospital, Nepal. Of 117 cervical biopsies received, 111 of these were included in the study. p16 and Ki-67 immunostaining were done on 71 cases with suspected intraepithelial lesion or malignancy. Results: Among 111 cases, chronic cervicitis was most common [58 (52.70%)], followed by premalignant lesions [33 (30.63%)] and invasive carcinoma [20 (17.11%)]. None of the cases of chronic cervicitis expressed p16, while 24 (73%) premalignant lesions and 17 (94.73%) invasive carcinomas were positive . Ki-67 score was 0 in 15 (83.30%) cases of chronic cervicitis but premalignant lesions and invasive carcinomas showed increasing positivity (scores 1-3). A significant correlation was observed between Ki-67 score and cervical neoplasia grade (p-value < 0.001). Concordance between H&E diagnosis and final diagnosis after IHC was 88% (κ = 0.853, P < 0.05). Conclusions: p16 and Ki-67 can be used as complementary, surrogate markers for HPV related cervical neoplasia and help in confirming the histologic diagnosis. These immunostains aid in accurate diagnosis of cervical intraepithelial lesions by reducing interobserver variability and aid in the distinction between reactive and neoplastic changes.
Background: HER2 overexpression in gastric cancer varies depending on tumor histology and anatomical location. This study aimed to score and evaluate the immunohistochemical marker HER2 in gastric adenocarcinoma and also to compare the expression of HER2 between gastro-oesophageal and gastric adenocarcinoma. Materials and Methods: A cross-sectional, retrospective study was conducted on 44 cases of histopathologically proven gastro-oesophageal and gastric adenocarcinoma by endoscopic Biopsy (41 cases) and gastrectomy (7 cases) specimens. Out of the 48 participants enrolled, we received both endoscopy and gastrectomy specimens from 4 cases. Hence, the analysis was based on the findings of 44 cases. HER2 immunohistochemistry was done on formalin-fixed paraffin-embedded tissues. Variables like age, gender, anatomical distribution of tumor, type of cancer, tumor grade and HER2 grade were studied. Results: Out of the 44 cases, the majority of the adenocarcinoma were gastric in origin [29/44 cases (65%)], with antral adenocarcinoma accounting for the largest proportion of gastric adenocarcinoma [12/29 cases (42%)]. HER2 overexpression was seen in 6/44 cases (14%) of the total cases. Well-differentiated adenocarcinoma showed maximum HER2 expression [4/8 cases (50%)] compared to moderately differentiated and poorly differentiated adenocarcinomas. Conclusions: HER2 overexpression is more frequent in well-differentiated gastric and gastro-esophageal adenocarcinomas, and in gastro-esophageal junction adenocarcinomas than in gastric adenocarcinomas.
Background: Breast cancer is an impending public health problem for developing countries. Fine needle aspiration cytology is a minimally invasive technique that yields rapid results and is cost-effective. Robinson’s cytological grade is simple, easily reproducible, and correlates precisely with the Modified Bloom-Richardson histological grade, which is the gold standard. This study aims to compare Robinson’s cytological grade with the Modified Bloom-Richardson histological grade. Materials and Methods: This is a prospective study where 36 patients diagnosed with breast carcinoma cytologically and confirmed histologically were enrolled. The study was carried out from January 2021 to January 2022 in the Department of Pathology, B.P. Koirala Institute of Health Sciences. Comparison of Robinson cytological grade with Bloom Richardson histological grade was done using concordance rate and absolute concordance rate. Results: The concordance rates of Robinson’s cytological grades I, II, and III were 77.8%, 62.5% and 54.5% respectively. The absolute concordance rate was 63.89%. There was a significant correlation between Robinson’s cytological grade and Modified Bloom- Richardson histological grade (p value=0.001, Tb=0.493). Conclusions: It is possible to grade breast carcinoma on fine needle aspiration cytology preoperatively, as it corresponds well with histological grade. This would allow the assessment of the tumors without any surgical intervention, so that morbidity associated with overtreatment of low-grade tumors or undertreatment of high-grade tumors can be avoided.
Balantidium coli, a largest protozoan, is a rare zoonotic disease in humans, predominantly detected in stool examination. We are presenting a case of incidentally detected urinary balantidiasis in a patient with genitourinary tract tuberculosis, which is the first case with such presentation.
Background: In the Bethesda System for Reporting Thyroid Cytopathology, category III is characterized by architectural and nuclear features that are indeterminate. This category continues to pose diagnostic and therapeutic dilemmas, with a variable risk of malignancy across different populations. Our study aimed to assess the risk of malignancy associated with Bethesda category III and the correlation of malignancy with each cytomorphologic feature within this category. Materials and Methods: All cases identified as Bethesda category III on fine needle aspiration cytology at The MES Medical College, Perithalmanna, India between January 2022 and September 2024 that had also had subsequent thyroidectomy at the same facility were retrospectively reviewed. The Ethical Committee gave its approval to the study (IEC/MES/F6/2025). In Bethesda Category III cytology, patient demographics, architectural characteristics, and cytological features were evaluated and compared to the final histopathological diagnosis in resected tissues. Results: Nuclear atypia was observed in 29 (61.7%) of the 47 Bethesda category III cases, with a 51.7% risk of malignancy. Features such as nuclear pseudo-inclusion (Risk of Malignancy-100%), membrane irregularity (p = 0.013), microfollicular pattern (p = 0.001), and crowded three-dimensional clusters (p = 0.003) were associated with an increased risk of malignancy. Conclusions: Risk of malignancy varies with different cytomorphological features, even within the AUS category. It is important to identify the nuclear and architectural features associated with a higher risk of malignancy and highlight them in the cytopathology report, which will help the clinician in patient management.
Adenosquamous and squamous cancer of the gall bladder are rare cancers with an incidence of only 5-10 % of total gall bladder malignancies. A 40-year female with complaints of nausea, pain in the abdomen, vomiting for 1 year, and jaundice for 2 years presented to the OPD. CECT revealed a gall bladder fossa mass with choledocolithiasis and dilated CBD, hepatosplenomegaly, and mesenteric lymphadenopathy. Histopathological examination done after surgery diagnosed as adenosquamous cancer of the gall bladder. When compared to adenocarcinoma, squamous cell carcinoma is a highly malignant neoplasm presenting at an advanced stage. Histologically, adenosquamous carcinomas show an admixed malignant glandular and squamous component. The squamous component is reported to grow twice as fast as the adenocarcinoma component. Squamous differentiation of malignancy in the gall bladder is a rare occurrence with poorer prognosis because the tumor tends to be bulky and locally infiltrative at presentation.
Background: Low-grade appendiceal mucinous neoplasm (LAMN) is a rare epithelial tumour of the appendix, accounting for 1% of gastrointestinal neoplasms and found in less than 0.3% of appendectomy specimens. It is histologically characterized by a villous or flat proliferative mucinous epithelium with low-grade cytological features. Prognosis depends on the presence of neoplastic epithelium and mucin outside the appendix, which increases the risk of peritoneal dissemination. The Present case series reviews 12 LAMN cases diagnosed between 2020 and 2024, analyzing clinical, radiological, and histopathological findings. Cases were staged using the AJCC 8th edition, emphasizing the importance of standardized examination for accurate diagnosis and prognosis. Results: The median patient age was 55 years, with a slight female predominance. Abdominal pain was the most common symptom. All cases exhibited intraluminal mucin with low-grade mucinous epithelium. Two cases had extra-appendiceal mucin (pT3 and pT4a), while the remaining were confined to the appendix (pTis). No recurrence was observed. Conclusions: LAMN remains a diagnostic and prognostic challenge, requiring thorough histopathological evaluation. Standardized staging and long-term follow-up are crucial for optimal management.
Background: Breast lesions are among the most common concerns presenting in surgical outpatient departments, often accompanied by anxiety over potential malignancy. Fine needle aspiration cytology offers a safe, reliable, and efficient diagnostic procedure that minimizes patient discomfort while providing rapid results. Materials and Methods: This hospital-based descriptive study was conducted in the Department of Pathology at Nepal Medical College Teaching Hospital over one year (August 2023 to July 2024) following ethical approval from the Institutional Review Committee. A total of 94 patients presented with breast lesions were included in the study. Cytology samples were collected through fine needle aspiration cytology, which was performed on each patient after obtaining written consent. The data was then entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0. Results: A total of 94 cases were enrolled in this study. The highest occurrence of breast lesions was observed in the 31–40 years age group. Benign breast lesions were more common in younger individuals, while malignant lesions were predominantly seen in older age groups. Benign breast lesions were more common in the left breast and the upper outer quadrant was the most commonly affected site. Out of 94 breast lumps, 11 cases (11.7%) were malignant and 83 (88.2%) cases were benign. Conclusion: Fine needle aspiration cytology serves as a secure and easy method for diagnosing breast lesions with minimal invasiveness.
Background: Palpable breast lump is a common clinical presentation, and about 10% of them turn out to be breast cancer. The triple diagnostic approach - clinical examination, mammography, and cytology assists in diagnosing and determining the need for histopathological confirmation. The present study aims to compare mammography and cytology against the histopathological diagnosis to determine the sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy of both techniques. Materials and Methods: This cross-sectional study, done from February 2023 to November 2024 included 50 patients presenting with a breast lump who underwent mammography, fine needle aspiration cytology (FNAC), and histopathological examination of the lump. Data were analyzed using SPSS software Ver.20, employing both descriptive and inferential statistics. Results: Out of 50 cases, 70%(35) were benign and 30%(15) were malignant. Fibroadenoma was the most common benign lesion 40%(20/50), while invasive ductal carcinoma was the most common malignant lesion 20%(10/50). Three-fourths of the benign cases occurred in patients under 45 years, while two-thirds of the malignant cases were in patients over 45. Mammography showed 60% sensitivity, 82.86% specificity, 60% positive predictive value (PPV), 82.86% negative predictive value (NPV), and diagnostic accuracy of 76%. FNAC showed 73.33% sensitivity, 97.14% specificity, 91.67% PPV, 89.47% NPV and diagnostic accuracy of 90%. Conclusions: Mammography and FNAC, when used together, supplement histopathological examination. FNAC offers higher accuracy than mammography and closely approximates histopathology in diagnosing breast lesions.
Superficial CD34 positive fibroblastic tumor is a rare soft tissue tumor first brought to light by Jodi M Carter in 2014. Several cases have been reported since, and they have been newly included in the recent WHO classification under the fibroblastic and myofibroblastic tumors category. It is a mesenchymal neoplasm of borderline malignant potential predominantly found in middle-aged adults with a median age of 37 years and most commonly located in the lower extremities. It is a spindle cell tumor with pleomorphic epithelioid cells, low mitotic activity, and strong diffuse positivity for CD34 on immunohistochemistry. The prognosis is good post excision but needs long-term follow-up since few cases revealed recurrences and lymph node metastases. As far as we know, only 64 cases have been documented thus far. We have reported a 63-year female with essential histological features of superficial CD34 positive fibroblastic tumor with no local recurrence or metastasis to date.
