Study of prostatic pathology and its correlation with prostate specific antigen level

Background: Diseases primarily inflicting prostate gland are inflammation, benign prostatic hyperplasia and cancer. Prostate specific antigen is a protein produced by the cells of prostate gland. It has been widely used in the diagnosis and management of patients with prostatic cancer. The aim this study was to determine the correlation between serum prostate specific antigen level and histological findings in biopsy specimens of men with prostatic disease.Materials and methods: This study was carried out at Kathmandu Medical College and Teaching Hospital, department of Pathology over a period of 2 years. One hundred and twenty eight cases with prostatic lesions were included in this study. Prostate specific antigen values of these cases were recorded before the surgical process. Histology of the tissue samples collected after transurethral resection of prostate was studied and relationship with prostate specific antigen level were analyzed.Results: Benign prostatic hyperplasia was the most common histological lesion encountered (n=95; 74.22%). Prostatic adenocarcinomas were seen a decade older than those with benign lesions. Maximum number of the benign cases had the Prostate specific antigen range of 0-7ng/ml. Most of the prostatic intraepithelial neoplasia lesions were seen within the PSA range of 0-7ng/ml and adenocarcinoma in the range of >20ng/ml.Conclusion: Prostate specific antigen is specific for the prostate but not for prostate cancer. Both benign and malignant lesions in prostate can cause increase in serum prostate specific antigen levels, but the chances of malignancy it rising level. 

Comparison of success rate of arterio-venous fistula in patients with diabetes vs non-diabetes

Introduction and objective: Definition of chronic renal disease is based on the presence of kidney damage or glomerular filtration rate (GFR 60 ml/min per 1.73 m2) for 3 months, irrespective of cause[1]. Once they are diagnosed as CKD, they are kept either on hemodialysis or peritoneal dialysis or patient undergo renal transplant.[2,3] With this research we may prove that even in a similar circumstances failure rate of AVF is more in diabetes patient.Materials and Methods: Total 50 patients of either gender were taken in this study. Inclusion criteria: CRF with GFR <30ml/min. Arterial diameter >1.5mm and venous diameter >2mm. Preoperative radial artery blood flow >30cm/min. Exclusion criteria: arterial diameter <1.5mm venous diameter <2mm.Written consent was taken from the patient. After preoperative workup surgery was done by 1st author. Arterio-venous fistula was scanned by color Doppler imaging after 4 weeks.Result: There were 31[62%] male, 19[38%] female. Mean age of patients was 55.8 years. 18[36%] were dialysis dependent. Cause of renal failure were diabetes 16(32%), unknown 15(30%), glomerulonephritis 8[16%] and obstructive uropathy 3[6%]. Mean internal diameter of radial artery was 1.91mm [1.5-2.6] and cephalic vein 2.57mm [1.9-3.2].7 patients had swelling of arm, 5 patients has surgical site infections and 15 patients had primary failure; 11 were from diabetic group and 4 from non-diabetic group. Mean duration of surgery was 60.95 minutes [50-75]. Average preoperative velocity in radial artery was 32.94[30-39]cm/sec. Average flow of blood at the end of 4 weeks was 461.42ml/min [0-654]. Between two groups failure rate was significantly high in diabetic patients [p = 0.02]. Failure rate was significantly higher in patients with diabetes more than 10 years [p=0.01].Conclusion: Failure rate of arterio-venous fistula is significantly high in diabetic patients.

Accuracy of fine needle aspiration cytology in diagnosis of thyroid swelling

Background: Fine needle aspiration cytology has been shown to be simple, safe, cost effective and quick to perform procedure with excellent patient compliance. It is a well established technique for preoperative investigation of thyroid gland swellings with high sensitivity, specificity and accuracy. The aim of this study was to determine the accuracy of fine needle aspiration cytology of thyroid swellings performed at our institution. Materials and Methods: This study was carried out at Kathmandu Medical College and Teaching hospital, department of Pathology over a period of 3 years (January 2010 to December 2012). Two hundred and seventy three patients of all age groups and both sexes who underwent fine needle aspiration cytology for thyroid swelling were evaluated. Out of 273 patients, histopathological diagnosis was available in 45 patients. Results: Fine needle aspiration cytology result revealed 245 cases (89.7%) as non-neoplastic, 21 cases (7.7%) as neoplastic and 7 cases (2.6%) inadequate due to lack of cellularity. The commonest lesion in the thyroid gland was colloid goiter. Among the malignant neoplasms the commonest was papillary carcinoma. Out of 273 patients, histopathological diagnosis was available in 45 patients. Statistical analysis of our data shows the diagnostic accuracy of fine needle aspiration cytology to be 95.7%. Fine needle aspiration cytology showed a sensitivity of 96.4% and a specificity of 94.4%. Conclusion: Fine needle aspiration cytology is a well established technique for pre operative investigation of thyroid gland swellings with high sensitivity, specificity and accuracy. DOI: http://dx.doi.org/10.3126/jpn.v3i6.8988Journal of Pathology of Nepal (2013) Vol. 3, 433-436  

Histopathological pattern of abnormal uterine bleeding in endometrial biopsies

Abnormal uterine bleeding is a common presenting complaint in gyanecology out patient department. Histopathological evaluation of the endometrial samples plays a significant role in the diagnosis of abnormal uterine bleeding. This study was carried out to determine the histopathological pattern of the endometrium in women of various age groups presenting with abnormal uterine bleeding. Endometrial biopsies and curettings of patients presenting with abnormal uterine bleeding was retrospectively studied. A total of 403 endometrial biopsies and curettings were analyzed. The age of the patients ranged from 18 to 70 years. Normal cyclical endometrium was seen in 165 (40.94%) cases, followed by 54 (13.40%) cases of disordered proliferative endometrium and 44 (10.92%) cases of hyperplasia. Malignancy was seen in 10 (2.48%) cases. Hyperplasia and malignancy were more common in the perimenopausal and postmenopausal age groups. Histopathological examination of endometrial biopsies and curettings in patients presenting with abnormal uterine bleeding showed a wide spectrum of changes ranging from normal endometrium to malignancy. Endometrial evaluation is specially recommended in women of perimenopausal and postmenopausal age groups presenting with AUB, to rule out a possibility of any preneoplastic condition or malignancy.

A study of ovarian cyst in a tertiary hospital of Kathmandu valley

Ovarian cysts are an extremely common gynecological problem. Majority of ovarian cysts are benign with few cases being malignant. This is a retrospective study of all the cases of ovarian cysts operated in a tertiary hospital (Kathmandu Medical College, KMC) from January 2006 to December 2008. In this 3 years duration, 102 cases (2.0%) were of ovarian cyst out of the total histopathological specimen processed in pathology department. The mean age of presentation was 38years. Ovarian cysts (27.5%) were more commonly seen in the age group 21- 30 years. Bilateral ovaries were involved in 19 cases (18.6%). Among these ovarian cysts, 89 cases (87.3%) were benign and 13 cases (12.7%) were malignant. The most common type of ovarian cyst was serous cystadenoma (40.2%) followed by mature cystic teratoma (15.7%). Metastasis to ovary was seen in 6.9% (7 cases). The most common metastasis was adeno carcinoma from gastro intestinal tract (4 cases). Other metastases to ovary were 2 cases from endometrioid adeno carcinoma of endometrium and 1 case from Non Hodgkin's Lymphoma of small intestine.

Cysticerci in palpable nodules diagnosed on fine needle aspiration cytology

INTRODUCTION

Cysticercosis is the larval manifestation of the cestode T. solium. It commonly presents as subcutaneous and intramuscular nodules which is often clinically misinterpreted as benign mesenchymal lesions and lymph nodes. Cysticerci in subcutaneous nodules can be diagnosed rapidly and with considerable accuracy by FNAC. This study highlights the cytomorphological features of subcutaneous cysticercosis diagnosed by FNAC.

METHODS

Forty three patients with palpable nodules diagnosed as cysticercosis or suspected as cysticercosis by FNAC between August 2005 to July 2008 were included in the study. Excision biopsy was done in 12 cases where definitive evidence of parasite was not found.

RESULTS

Solitary nodules were present in 36 (83%) patients and multiple nodules were present in seven (17%). In 31 cases (72.09%) definite evidence of cysticercus was found. In 12 cases (27.9%) a suggestion of parasitic inflammation was made based on other cytomorphological features which was confirmed by biopsy in eight cases.

CONCLUSIONS

Human cysticercosis commonly presents as subcutaneous nodules which can be diagnosed with considerable accuracy by FNAC. Definite evidence and suggestion of parasitic inflammation on cytology obviates the need for subsequent histopathological examination.

Cysticerci in Palpable Nodules Diagnosed on Fine Needle Aspiration Cytology

Abstract

Evaluation of fine needle aspiration cytology of lymph nodes in Kathmandu Medical College, Teaching hospital

BACKGROUND

Fine Needle Aspiration Cytology (FNAC) is a simple and rapid diagnostic technique. Because of early availability of results, simplicity, minimal trauma and complications, the aspiration cytology is now considered a valuable diagnostic aid and is part and parcel of a pathologist's repertoire.

OBJECTIVES

The aim of the study was to evaluate the results of fine needle aspiration cytology (FNAC) of lymph nodes in our institution in comparison to result of histopathology.

MATERIALS AND METHODS

The present study on 130 patients of lymphadenopathy was conducted in the Department of Pathology Kathmandu Medical College Teaching hospital, Kathmandu from June 2006 to May 2008 (2 years).

RESULTS

In this series of FNAC cervical lymph nodes were 66 (50.76%), and axillary lymph nodes were 20 (15.38%). Male to female ratio of the patients was 1: 0.9. The age of patients ranged from 3 to 85 years. FNAC diagnosis was found to be as follows : reactive hyperplasia 54( 41.55%), tubercular lymphadenitis 36 (28 %), metastatic carcinoma 16 (12.3%), granulomatous lymphadenitis 12 ( 9.2 % ), lymphoma 8 (6%) and suppurative lymphadenitis 4(3%) . Out of 28 cases of FNAC 26 (92.85%) were consistent with histopathological diagnosis of tubercular lymphadenitis. In metastatic carcinoma to lymph nodes sensitivity and specificity of FNAC were 100% each.

CONCLUSION

FNAC is useful and reliable in diagnosing neoplastic and non- neoplastic lesions of lymph nodes. It helps in planning surgery for malignant cases, where definitive operative intervention can be performed in one session.

Role of FNAC in the diagnosis of salivary gland swellings

OBJECTIVES

The aim of this study was to evaluate the diagnostic accuracy and efficacy of Fine needle aspiration cytology (FNAC) in various salivary gland swellings.

MATERIALS AND METHODS

This retrospective study was performed at Kathmandu Medical College Teaching Hospital (KMCTH) from January 2004- December 2006.During this period a total of 978 FNAC's were done out of which 40 FNAC's were on salivary gland swellings. Correlation was done between cytological smear slides and biopsy slides.

RESULTS

In this series of FNAC, 16 cases (40%) were benign neoplasms, 5 cases (12.5%) malignant neoplasms, non-neoplastic cysts 3 cases (7.5%) and inflammatory lesions 16 cases (40%).Histopathology was available in 24 cases out of which 22 cases correlated with cytology. There were no false positive reports but false negative result was seen in 4 cases. Sensitivity and specificity were 90% and 100% respectively.

CONCLUSION

FNAC is useful in the diagnosis of salivary gland swellings especially in benign conditions with a sensitivity of 90% and specificity of 100%.

Fine needle aspiration (FNA) of soft tissue tumours (STT)

OBJECTIVES

The cytological findings of 50 ST Ts were evaluated aiming to determine the role of FNA in diagnosis of STTs

METHODS

Fifty patients with soft tissue tumours underwent FNA in the preoperative investigation during a one year period. The smears were stained with Papanicolaou and May-Graunvald Giemsa stains.

RESULTS

Forty-four cases were reported as benign, whereas 2 were malignant. Four cases revealed insufficient material. The malignant STTs were small round cell tumour and malignant spindle cell tumour. Cytological and histological correlation could be achieved in 40 cases. The overall sensitivity and specificity were 25% and 100% respectively with overall accuracy of 80%.

CONCLUSION

A reliable diagnosis of STTs can be made with FNA when supported by other clinical and other diagnostic data.