Smriti Karki

Diagnosis of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) by fine needle aspiration cytology.

Sinus histiocytosis with massive lymphadenopathy (Rosai‐Dorfman disease) is a rare benign disease of unknown etiology presenting with massive lymphadenopathy. We report four cases of this disease retrieved from the archives of cytopathology laboratory, BPKIHS, Dharan, Nepal, during the period of January 2002 to October 2007. The cytologic morphology revealed lymphocytes, plasma cells, and single to multinucleated histiocytes with well preserved lymphocytes in their cytoplasm (emperipolesis or lymphophagocytosis). It is concluded that FNAC is a useful and reliable tool for the diagnosis of sinus histiocytosis with massive lymphadenopathy (Rosai‐Dorfman disease) and biopsy can be avoided in these patients, thereby reducing patient inconvenience and health care cost. Diagn. Cytopathol. 2008;36:691–695.

Benign cystic mesothelioma of the peritoneum in a child—case report and review of the literature

A 4-year old female child presented with clinical features of ascites that, on computed tomography, showed a huge thin-walled cystic lesion in the peritoneum. Laparotomy confirmed a unilocular cyst in the peritoneum adhered to the parietal wall and bowel but not originating from any internal organs. Histopathologic examination of the cyst wall was consistent with the diagnosis of benign mesothelioma. Benign cystic mesothelioma of the peritoneum has rarely been reported in children.

Role of fine needle aspiration cytology in diagnosis of filarial infestation

Filariasis is a tropical disease transmitted by the Culex mosquitoes. The diagnosis of it is conventionally made by demonstrating microfilariae in the peripheral blood smear. However; microfilariae and adult filarial worm have been incidentally detected in fine needle aspirates of various lesions in clinically unsuspected cases. The cases of filariasis diagnosed by fine needle aspiration cytology (FNAC) were retrieved from the archives of the Cytopathology laboratory between the periods of January 1998 to February 2009. Both Papanicolaou‐ and May–Grunwald–Giemsa‐stained smears were available in all the cases. A total of 26 diagnosed cases of filariasis were found, of which 19 were related to funiculo‐epididymitis, four presented with breast lump, and three cases with lymphadenopathy. Smears revealed fragments of adult worm in 12 cases including 10 gravid female worm containing eggs and microfilariae and two male adult worm; whereas in remaining 14 cases only microfilariae or eggs were seen. Unfertilized eggs were seen in three cases and fertilized eggs were seen in five cases. Tissue response in the form of eosinophils in 16 cases, acute inflammatory exudate in five cases, macrophages in 22 cases, epitheloid cell granulomas in five cases, giant cells in four cases, lymphocytes in 10 cases, and plasma cells in three cases were seen. Adherence of polymorphonuclear leukocytes, eosinophils, and epithelioid cells were observed in four cases. On conclusion, filaria may affect the epididymis, spermatic cord, breast, and lymph node, and the accurate diagnosis can be easily and conveniently achieved by FNAC without any requirement of biopsy. Diagn. Cytopathol. 2011;39:8–12.

Primary laryngeal leishmaniasis: a rare case report.

Laryngeal leishmaniasis is extremely rare. We report a case of primary laryngeal leishmaniasis in a 70-year-old male who was admitted with complaints of gradual progressive hoarseness of the voice, dyspnea, cough for the past 3 months and noisy breathing for the past 5 days. An X-ray of the soft tissue of the neck showed a prevertebral soft tissue mass causing narrowing of the airway at the C6-C7 vertebral level. A computerized tomography (CT) scan showed a soft tissue mass in the subglottic region causing significant narrowing of the airway. A direct laryngoscopy showed a pinkish-white, friable mass involving the subglottic region and the anterior half of the vocal cords. With the clinical suspicion of malignancy, an endoscopic biopsy was done. A histopathological examination showed diffuse mixed inflammatory cell infiltrate in subepithelium with numerous Leishmania donovani bodies in the cytoplasm of histiocytes.

Clinicopathological Features and Complications of Thyroid Operations: A Single Centre Experience

Thyroid surgery evolution is important with a lots of hurdles faced by many surgeons to reach the present stage. The complications from the olden days reduced with improvement in understanding the disease process, development of antibiotics, anaesthesia and now restricted mainly to hypoparathyroidism and recurrent laryngeal nerve injuries. A retrospective analysis of thyroid surgeries performed at BP Koirala Institute of Health Sciences centre from 2007 to 2011 Clinicopathological features and complications were analyzed. Among 203 patients who underwent surgery for thyroid operations, 53 were malignant and 150 were benign cases. Hemithyroidectomy was the most common procedure performed (118 cases). Papillary thyroid cancer was the most common malignant lesion and colloid goiter the most common benign lesion. Postoperative complications occurred in 12 patients—infection in two patients, bleeding requiring reexploration in one patient, hypocalcemia in 6 (5-transient and 1-permanent) and hoarseness of voice in three patients (2-temporary and 1-permanent). FNAC is an easy, cost effective, reliable investigation in experienced hands. Reoperation, primary stage of the tumor and central node dissection are associated with increased complication rates.

Endoscopic medial maxillectomy for sinonasal inverted papilloma

Background : Traditionally, medial maxillectomy was performed through lateral rhinotomy or mid facial degloving approach for inverted papilloma. Endoscopic medial maxillectomy, since reported first in 1992, has advanced tremendously and has been advocated by a number of authors for the fact that it prevents the morbidity of open approach with a similar recurrence rate. We present our experience of endoscopic medial maxillectomy for sinonasal inverted papilloma. Aims and Objective: To highlight the treatment of inverted papilloma through transnasal endoscopic approach. Methods: This study is a retrospective chart review of 18 patients out of 23 patients of which 5 were lost on follow-up with inverted papilloma who were treated during the last 2 years. Preoperative diagnosis was made on histopathological examination and Krouse staging in CT scans of paranasal sinus was used to estimate the extent of the disease. Then, surgical approach was decided. Post-operative follow up was done by performing direct nasal endoscopy. All patients were followed up for a minimum period of 1 year. Results : Among the 18 patients who underwent endoscopic medial maxillectomy, sex (male : female) ratio were 1.25: 1, age ranged from 24 yrs to 69 yrs with average being 41.7 yrs. According to Krouse staging, 2 patients were in Stage I, 9 patients in Stage II and 7 patients in Stage III. The laterality of the lesion was more on the right. The commonest site of attachment was found to be the lateral wall of nose. The average duration of hospital stay was 4 days. The commonest complication was nasal crusting and the recurrence rate was 11.11%. Conclusion : This work confirms the results described in recent literature and further supports transnasal endoscopic surgery to manage inverted papilloma. Journal of BP Koirala Institute of Health Sciences , Vol. 1, No. 1, 2018, Page: 20-24

Proposition of Fine Needle Aspiration Cytology as a Diagnostic Tool in Cases of Cysticercosis by

Introduction: Cysticercosis in humans caused by the larval stage of Taenia solium is quite common in developing countries, including South Asia, and poses a serious health challenge in these countries. This study was mainly undertaken to prove the utility of fine needle aspiration cytology (FNAC) in the diagnosis of cysticercosis. Materials and methods: The study included cases diagnosed with cysticercosis by FNAC from January 2008 to December 2015 who were reviewed for clinical data, cytomorphologic findings, and, when available, histopathologic findings. Results: The study included 24 cases, the majority being women (67%) with a median age of 28 years. Most cases presented with head and neck swelling which was firm and nontender. Aspiration yielded a clear fluid aspirate in most cases (33%). Cytology revealed the presence of wall of parasite in all cases, with the presence of hooklets in 3 cases. Conclusions: This study reinforces that in cases where a definite parasitic parenchymal layer can be seen, FNAC eliminates even the need for biopsy for confirmation.

Crohn disease in Nepal: true rarity or gross underdiagnosis?

Gross and histopathological examination of a resected segment of ileum in a 72-year-old man with the preoperative diagnosis of small intestinal perforation peritonitis revealed the first-ever diagnosed case of Crohn Disease (CD) at the B P Koirala Institute of Health Sciences, Dharan, Nepal. In view of the recent reports on rising incidence of CD in neighbouring Asian countries, it was decided to perform an exhaustive literature search to find out the documented prevalence of CD in Nepal. It was surprising to find only a single case of CD from Nepal, occurring in the year 1980, to be documented in English literature. Further, the index case of CD presenting with acute abdomen is of interest since only about 100 cases of CD with small intestinal perforation have been so far reported worldwide.