NepMed Repository :: Browsing by Author "Hirachand, S"

Browsing by Author "Hirachand, S"

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A Histopathological Study of Gastrointestinal Polyps in Tertiary Care Hospital, Nepal
(Institute of Medicine, 2014) Gurung, P; Hirachand, S; Pradhanang, S; Lama, S
Abstract Introduction: Gastrointestinal polyps may be non-neoplastic or neoplastic lesions. They are mostly asymptomatic and are common in the colon but may occur anywhere in the gastrointestinal tract. Some polyps have an increased risk for malignancy, so it is important to determine the histologic type and characteristics for treatment. This study was undertaken to determine the histomorphological spectrum of polyps, their potential risk for malignancy, and frequency in our center. Methods: This is a descriptive study which was carried out at Kathmandu Medical College Teaching Hospital for a period of three years from 1st January 2011 to 31st December 2013. A total of 67 polypectomy specimens were received and processed in the Pathology Department. Hematoxylin and Eosin stained slides were examined. Results: 47 (70.1%) gastrointestinal polyps were non-neoplastic, 19 (28.3%) were neoplastic and 1 (1.6%) was an infarcted polyp. Most of the patients presented with rectal bleeding. The age of patients for non-neoplastic and neoplastic polyps ranged from 3-74 and 23-78 years, respectively. Amongst the non-neoplastic polyps, 21 (44.7%) were retention polyps, 14 (29.8%) were inflammatory polyps, 10 (21.3%) were hyperplastic polyps, 1 (2.1%) benign gastric polyp and 1 (2.1%) non-categorized polyp. The neoplastic polyps had 16 (84.1%) adenomatous polyps, 1 (5.3%) mixed polyp, 1 (5.3%) fundic gland polyp, and 1 (5.3%) moderately differentiated adenocarcinoma. 11 (68.8%) adenomatous polyps had mild dysplasia, 2 (12.5%) moderate dysplasia, and 3 (18.7%) severe dysplasia. Size of the non-neoplastic polyps ranged from 0.2-5.0 cm and size of neoplastic polyps ranged from 0.3-6.0 cm in diameter. Some patients presented with more than one polyp. Conclusion: Polyps have a diverse histomorphology and there is a risk of malignancy in the adenomatous polyps so it is important to screen patients for treatment and cancer prevention. Keywords: adenomatous polyps, hyperplastic polyps, inflammatory polyps, retention polyps
Clinico-Haematological Profile of Megaloblastic Anaemia
(Institute of Medicine, 2014) Hirachand, S; Singh, R; Gurung, P; Thapa, R
Abstract Introduction: Megaloblastic anaemia is one of the important causes of anaemias. It is a macrocytic anaemia resulting from abnormal maturation of hematopoietic cells due to faulty DNA synthesis. Two vitamins, cyanocobalamin (vitaminB12) and folic acid are essential for DNA biosynthesis. Deficiency of either vitamin results in abnormal nuclear maturation with normal cytoplasmic maturation, apoptosis, ineffective erythropoiesis, intramedullary haemolysis, pancytopenia and typical morphological abnormalities in blood and marrow cells. Methods: This descriptive study was carried out for two and a half years (July 2011 to December 2013) in the department of Pathology, Star hospital, Kathmandu, Nepal. Out of 885 anaemic patients 55 diagnosed as megaloblastic anaemia were included in the study. Complete blood count, reticulocyte count, peripheral smear and bone marrow examination were performed. Serum vitamin B12 and folic acid estimation was done in 32 cases. Results: Out of 55 cases of megaloblastic anaemia, 31 were female and 24 were male with a female to male ratio of 1.3:1. Age range was 18 to 80 years. Pallor was the predominant clinical finding in these cases. Twenty cases (36.36%) presented with only anaemia while others presented with pancytopenia or bicytopenia. Of the 55 cases of megaloblastic anaemia,32 had assays done for cobalamin and folate, of which 15 (46.88%) had cobalamin deficiency, 4 (12.5%) had folate deficiency and 13 (40.62%) had combined deficiency. Conclusion: Megaloblastic anaemia can present with varied clinical manifestations. Strong suspicion of megaloblastic anaemia should be entertained by clinicians to improve clinical outcome. Prompt diagnosis is important as it is a completely curable condition. Keywords: Anaemia, Cobalamin and folate deficiency, Megaloblastic anaemia
Diagnostic role of fine needle aspiration cytology in the evaluation of salivary gland lesions
(Institute of Medicine, 2017) Hirachand, S; Kafle, N; Thapa, R; Gurung, P
Abstract Introduction: Fine needle aspiration cytology (FNAC) is a popular method for diagnostic evaluation of salivary gland lesions due to their superficial nature and easy accessibility for the procedure. The technique is simple and cost effective. The present study was conducted to evaluate the diagnostic accuracy of fine needle aspiration cytology in various salivary gland tumors, which helps in an early diagnosis and appropriate therapeutic management. Methods: The study was conducted in the Department of Pathology in Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal from October 2014 to September 2016 (2 years). A total of 48 fine needle aspirations of salivary gland lesions were done, of which histopathological conformation of diagnosis was available in 34 cases. A standard cytological and histopathological staining were used and examined. Results: Forty eight cases of salivary gland lesions were included in the study. The age of patients ranged from 6 to 88years, with a mean age of 46years. Male: female ratio was 1.4:1 with common site being the parotid gland. Histopathological conformation of diagnosis was available in 34 cases. Pleomorphic adenoma was found to be the most common benign tumor (50%) and mucoepidermoid carcinoma (14.70%) was the commonest malignant tumor. The overall diagnostic accuracy of FNAC in diagnosing salivary gland lesions was 89.47% with a sensitivity of 77.77 and a specificity of 93.10%. Conclusion: Fine needle aspiration cytology is an important and useful diagnostic tool for diagnosing salivary gland lesions. Proper sampling of lesions and adequate cellularity of the smears are the pre- requisites for accurate diagnosis. Hence, the appropriate therapeutic management could plan earlier. Keywords: Cytology, Fine needle aspiration cytology, Salivary gland lesions
Efficacy of bronchial cytology in diagnosing lung lesions and its correlation with bronchial biopsy
(Institute of Medicine, 2018) Hirachand, S; Sthapit, RR; Gurung, P; Acharya, S
Abstract Introduction: Neoplastic and non-neoplastic lung lesions have a high rate of morbidity and mortality. Lung cancer is the frequently diagnosed cause for cancer related deaths and tuberculosis is still the leading cause of death in developing countries. Timely detection of disease plays an important role in the management and long term survival of patients. For early diagnosis different diagnostic modalities are available which include bronchoalveolar lavage, bronchial brush, fine needle aspiration cytology and bronchial biopsy. Bronchoalveolar lavage and bronchial brush are very effective in the diagnosis and differential diagnosis of lung cancers. Bronchial brushings often offer excellent specimens and accurate information about the site of the lesion. Better diagnostic yield is often obtained when cytologic techniques are used together with bronchial biopsy.The present study was undertaken to ascertain the role and diagnostic utility of bronchoalveolar lavage, bronchial brush and bronchial biopsy in diagnosing lung lesions. Method: A prospective study was conducted in the Department of Pathology in Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal from January 2016 to December 2017 (2 years). A total of 48 cases were included in the study. Bronchoalveolar lavage, bronchial brush and bronchial biopsy slides were stained with routine cytological and histological staining and examined. Results: Out of 48 cases, bronchoalveolar lavage smears revealed 24 non-neoplastic, 19 neoplastic and 5 suspicious cases. Bronchial brush smears revealed 24 neoplastic, 22 non-neoplastic and 2 suspicious cases. Bronchoscopic biopsy revealed 31 neoplastic and 17 non-neoplastic lesions. The bronchial brush cytology showed sensitivity of 82.76%, specificity of 89.47% and accuracy of 85.42%. Conclusion: Combination of bronchial cytology and biopsy can be considered as the best procedures for the diagnosis of lung lesions. Keywords: Bronchoalveolar lavage, Bronchial brush, bronchial biopsy, non-neoplastic and neoplastic lung lesions
Evaluation of fine needle aspiration cytology of lymph nodes in Kathmandu Medical College, Teaching hospital
(Kathmandu University, 2009) Hirachand, S; Lakhey, M; Akhter, J; Thapa, B
Abstract 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. Th 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. Key words: FNAC, lymphadenopathy.
Fine needle aspiration (FNA) of soft tissue tumours (STT)
(Kathmandu Unversity, 2007) Hirachand, S; Lakhey, M; Singha, AK; Devkota, S; Akhter, J
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. Key words: FNA, soft tissue tumours
Histopathological study of ovarian cystic lesions in Tertiary Care Hospital of Kathmandu, Nepal
(Institute of Medicine, 2013) Gurung, P; Hirachand, S; Pradhanang, S
Abstract Introduction: Ovarian cysts are commonly encountered lesions. They are amongst the most frequent cause of hospitalization and surgery in gynecological practice. One cannot confidently distinguish a benign lesion from a malignant one on the basis of clinical, radiological or gross characteristics along so a histopathology examination is a must as it guides therapy. The study was undertaken to determine the morphologic spectrum of the cystic lesions of the ovary. Methods: This is a descriptive study which was carried out at Kathmandu Medical College Teaching Hospital for a period of two years from 1st January 2011 to 31st December 2012. A Total of 135 cases of ovarian cysts were received and processed in the Pathology Department. Hematoxylin and Eosin stained slides were examined. Results: Among the 135 ovarian cystic lesions, 119 cases (88.15%) were unilateral and 16 cases (11.85%) were bilateral. There were 59 cases (43.7%) of benign cysts, 69 cases (51.1%) of benign tumors, 5 cases (3.7%) of malignant tumors and 2 cases (1.5%) of borderline epithelial tumors. The age of patients ranged from 13 years to 73 years with mean age of presentation of 43 years. Among the ovarian cystic lesions the incidence of mature cystic teratoma was the highest (30%). The most common non-neoplastic cyst was endometriotic cyst (39%), while the most common benign tumor was mature cystic teratoma (58%). The malignant tumor encountered in the study was serous cystadenocarcinoma. Two cases of borderline epithelial tumors (1.5%) were also observed in the study. Conclusion: The most common cystic lesion that were encountered in the study was benign tumor followed by benign cyst. Of the benign tumors, mature cystic teratoma was the most frequently observed lesion. Among the non-neoplastic cysts, endometriotic cyst was the most frequently observed lesion. Keywords: borderline tumors, endometriosis cyst, mature cystic teratoma, Ovarian cyst, serous cystadenocarcinoma
Role of FNAC in the diagnosis of salivary gland swellings
(Kathmandu University, 2008) Akhter, J; Hirachand, S; Lakhey, M
Abstract 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%. Key words: Fine needle aspiration cytology (FNAC); Salivary gland swelling (SGS)
Utility of Rapid Brilliant Cresyl Blue Stain in Routine Fine Needle Aspiration Cytology
(Institute of Medicine, 2017) Gurung, P; Hirachand, S; Thapa, R; Pradhanang, S; Kafle, N; Acharya, S; Sedhain, M
Abstract Introduction: Rapid on-site evaluation is commonly performed by pathologists to check for cellular adequacy of fine needle aspirate smears to reduce hospital visits of patients and to make preliminary diagnosis. For rapid evaluation, laboratories use Romanowsky stain, Hematoxylin and Eosin stain, supravital stains and ultra-fast Papanicolaou stain. The aim of the study is to evaluate fine needle aspirate smears on-site for sample adequacy using supravital stain Brilliant Cresyl Blue (BCB), to make preliminary cytological diagnosis and to compare with the routine cytological Papanicolaou stain (Pap) and Giemsa stain. Methods: The study was carried out in the Department of Pathology, Kathmandu Medical College Teaching Hospital from 1st December, 2014 to 31st December, 2015. A total of 115 cases referred from OPD for FNAC were included in the study. FNA was performed under aseptic conditions with a 23-guage needle. Samples were collected for routine stains (Papanicolaou and Giemsa stain) and one air-dried slide was stained with Brilliant Cresyl Blue and examined immediately while patient was in waiting room. Results: Of the 115 cases, the age of patients ranged from 15 to 83 years in which male and female ratio was 1.5:1. There were 35 (30.4%) cases of enlarged lymph nodes, 28 (24%) cases of thyroid lesions, 20 (17.3%) cases of breast lesions, 7 (6%) cases of soft tissue lesion, 3 (3%) cases of salivary gland lesions, 1 (1%) case of lung mass, 1 (1%) case of epididymal swelling and others 20 (17.3%) cases. On rapid staining with brilliant cresyl blue, case sample adequacy was 104 (90%). Repeat aspiration was done in 11 (10%) of cases .Upon rapid staining, 92 (80%) of the cases were benign, 19 (17%) cases were malignant, 4 (3%) cases were inconclusive. After observation of papanicolaou and giemsa stains, there were 94 (82%) benign cases and 21 (18%) malignant cases. Conclusion: On-spot Brilliant Cresyl Blue staining is a good stain to check for sample adequacy and to reduce reaspirations. It is as good as the conventional stains in exhibiting cytomorphology of cells. Keywords: Brilliant Cresyl Blue, cytomorphology, fine needle aspiration cytology, Giemsa stain, Papanicolaou stain

Browsing by Author "Hirachand, S"

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