Shatrughan Prasad Sah

Fine needle aspiration cytology of tubercular epididymitis and epididymo-orchitis.

OBJECTIVE To study the role of fine needle aspiration cytology (FNAC) and ancillary studies in the diagnosis of tubercular epididymitis or epididymo-orchitis. STUDY DESIGN Forty patients with tubercular epididymitis or epididymoorchitis diagnosed on FNAC underwent a detailed clinical workup, imaging and microbiologic studies before being started on antitubercular treatment (ATT). One patient underwent orchiectomy. RESULTS Clinically, the disease presented in patients of all ages usually as a scrotal swelling or rarely as a scrotal sinus (3) or abscess (3) or as part of disseminated tuberculosis (2). Three patients gave a history of previous tuberculosis. Scrotal sonography confirmed the involvement of the epididymis, testis or spermatic cord in each case. FNAC was diagnostic in 27 aspirates (epithelioid cell granulomas with caseation) but nondiagnostic in the rest. Tubercular etiology was confirmed directly by detection of acid-fast bacilli (AFB) on FNA smears in 24 (60%) patients and urine samples in 11 and indirectly in 9 patients with negative AFB by using a combination of a positive Mantoux test (5 of 9), presence of caseating granulomas on FNA smears (7 of 9) and therapeutic response to ATT (9 of 9). CONCLUSION FNA as a minimally invasive technique plays a prime role in the diagnosis of tubercular epididymitis and epididymoorchitis. It provides adequate material for cytologic and microbiologic examination and helps to avoid unnecesary orchiectomy.

Enterobius vermicularis causing symptoms of appendicitis in Nepal.

This study set out to determine the prevalence of Enterobius vermicularis in surgically removed appendices and to assess the possible relation of the parasite to acute appendicitis. All 624 surgically removed appendices received in the Department of Pathology, BPKIHS, Dharan, Nepal during 2½ years (August 1999–January 2002) were examined. E. vermicularis was identified in nine (1.62%) appendices from the patients with a clinical diagnosis of appendicitis. The parasite was most frequently seen in histologically normal appendices (6/71) and was rarely associated with histological change of acute appendicitis (3/539). No cases of E. vermicularis infestation occurred in appendices showing chronic inflammation or removed during the course of other surgical procedures. E. vermicularis was found more frequently in uninflamed and histologically normal appendices (8.45%) than those which were inflamed with histopathologic changes of acute appendicitis (0.56%). It may be a cause of symptoms resembling acute appendicitis although the mechanism for this does not involve mucosal invasion by the parasite.

Germ cell tumors of the ovary : A clinicopathologic study of 121 cases from Nepal

Background:  Although many reports have been published about germ cell tumors of the ovary in developed countries, there has been no such documentation from Nepal. The retrospective study presented here reports the clinicopathologic profile of germ cell tumors of the ovary studied at B. P. Koirala Institute of Health Sciences, Dharan, Nepal.

Clinical presentation of retinoblastoma in Eastern Nepal.

Background:  The purpose of the present study was to determine modes of presentation of retinoblastoma and the association between proptosis with orbital extension and histopathologically detectable optic nerve infiltration by the tumour.

Lymphangioma Circumscriptum of the Vulva Mimicking Genital Wart: A Case Report and Review of Literature

Lymphangioma circumscriptum (LC) is an uncommon dermatologic problem that rarely affects the vulva and it is considered to be a localised developmental defect of lymphatic tissue in the dermis. We report a case of vulval LC, clinically diagnosed as genital wart, in a 48‐year‐old woman without evidence of secondary lymphatic damage. The patient required extensive vulval surgery and there was no recurrence after 16 months.

Primary malignant tumours of eye and adnexa in Eastern Nepal

Background: The purpose of the present paper was to report the spectrum of primary malignant tumours of eye and adnexa at BP Koirala Institute of Health Sciences, Nepal, from 1995 to 2000.

Acne in Becker's nevus

An 18‐year‐old man presented with a progressively enlarging, asymptomatic, well‐demarcated, irregular, hyperpigmented patch, 13 cm × 11 cm, on the anterior aspect of the chest below the left clavicular region, with a few small macules at the periphery, of 2 years duration. After 18 months, multiple, discrete, erythematous papules and comedones developed over the patch ( Fig. 1 ). A few melanocytic nevi were present in and around the patch. A clinical diagnosis of Beckers nevus with acne vulgaris was made. A skin biopsy from the patch showed acanthosis, elongated rete ridges, increased pigmentation in the basal layer, and a mild perivascular lymphocytic infiltrate in the upper and lower dermis with few melanophages in the dermis. Histopathology of the comedone revealed slight acanthosis, irregular elongation of the rete ridges, and hyperpigmentation of the basal layer of the epidermis. Multiple melanophages were seen in the upper dermis. In the mid‐dermis, a ruptured closed comedone was seen. The follicular lumen contained a plug of loosely arranged keratinized cells, sebaceous material, and bacterial colonies. Aggregates of neutrophils were found at the site of rupture of the follicular wall. There was a mild perivascular lymphocytic infiltrate in the upper and lower dermis ( Fig. 2 ). These features confirmed the diagnosis of Beckers nevus with acne vulgaris. The acne was treated with 0.05% tretinoin and 2% erythromycin creams. After 2 months of treatment, all the acne lesions subsided. On further follow‐up, the patient had relapse of the acne lesions over the patch with the discontinuation of treatment. A few new lesions also appeared on the face. The treatment was restarted, but the patient was lost to follow‐up.

Lichen planus after HBV vaccination in a child: a case report from Nepal.

Vaccination against hepatitis B virus has rarely been associated with lichen planus. We report a case of this kind in a child from Nepal. A 12‐year‐old boy had developed generalized itchy violaceous papules and plaques six weeks after the second dose of hepatitis B virus vaccine. Serum HBsAg and HBeAb were negative, but HBsAb was positive. New crops of generalized, similar eruptions developed after the booster dose of vaccine. All the lesions resolved within three months of systemic steroid therapy. There was no recurrence after one year of follow up. Awareness of such an association is necessary, especially in children, because vaccination campaigns are increasing.

Diagnostic value of fine needle aspiration cytology in gouty tophi: a report of 7 cases.

UNLABELLED BACKGROUND The diagnosis of gout can be problematic when the presentation is atypical and serum uric acid is borderline elevated. Demonstration of monosodium urate (MSU) crystals in fine needle aspiration (FNA) smears from nodular masses clinically suspected to be tophi establishes the diagnosis unequivocally. CASES Of the 7 cases in this study, 4 were suspected clinically to have gouty tophi. Giant cell tumor of tendon sheath, giant cell tumor of bone and metastatic tumor with multicentric involvement of bone were the clinical diagnoses in 1 case each. Serum uric acid levels high enough to be in the diagnostic range for gout were reported in 3 cases, within normal limits in 3 cases and low in 1 chronic alcoholic patient. Bright field microscopy of FNA smears revealed singly scattered or stacks of MSU crystals with variable number of inflammatory cells, with or without foreign body giant cells in 6 cases. In 1 patient, FNA showed stacks of MSU crystals only. Characteristic birefringence of MSU crystals was observed on polarizing microscopy. CONCLUSION FNA demonstration of MSU crystals on polarizing microscopy can easily establish the nature of the nodules in and around the joints and in soft tissue as gouty tophi and is thus an investigation differentiating this lesion from other masses clinically simulating it.

Kala Azar Associated With Malaria

22-year-old man presented with complaints of mildto moderate-grade fever with chills and rigor, cough with scanty expectoration, and progressive weight loss of 1 month’s duration. On examination, he was pale, febrile, and had normal vital signs. Multiple superficial lymph nodes in the cervical and axillary regions were palpable, varying from 1.5 to 2.5 cm in diameter. The glands were nontender, matted, firm, and mobile. Liver and spleen were enlarged 2 and 3 cm below the costal margin, respectively. Other systems were normal. A clinical diagnosis of disseminated tuberculosis was considered. Laboratory investigations revealed the following values: hemoglobin, 5.2 g/dL; total leukocyte count, 3400/mm 3 , with a differential count of 57% polymorphs, 41% lymphocytes, and 2% monocytes. Erythrocyte sedimentation rate (Westergren) was 76 mm in the first hour, and the platelet count was 1 50 000/mm 3 . Peripheral blood smear showed normocytic hypochronic to macrocytic red cells, neutrophils with prominent toxic granules, and no malar