Browsing by Author "Sayami, G"
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Publication A case of leiomyosarcoma of the kidney(Institute of Medicine, 2006) Adhikari, RC; Sayami, G; Dali, S; Shrestha, HGAbstract Introduction: Sarcomas of the kidney are rare.Among primary sarcomas, leiomyosarcoma is the most frequent. A case of primary renal leiomyosarcoma is presented. Case report: This report concerns a 48-year-old woman, who presented with slowly increasing right flank mass and dull aching pain. A well-defined, gray, firm mass measuring 12.5 x 10.5 cm was histologically composed of interlacing bundles of spindle cells with cellular atypia and nuclear hyperchromasia. Mitotic figures constituted 10-12/ 10 HPF. Tumor cells showed positivity for desmin. The differentiation from sarcomatoid renal cell carcinoma is discussed. Conclusion: The case is reported for its rarity and this is the first reported case of renal leiomyosarcoma in Nepal.Publication Gall bladder tuberculosis: a rare entity(Institute of Medicine, 2006) Lakhey, P; Shrestha, ML; Sayami, G; Khakurel, MPAbstract Background: Though tuberculosis is common in other parts of the body, gall bladder tuberculosis is rare. We report a case of gall bladder tuberculosis managed in our institution. Case Report:A 42 year old lady presented with right upper quadrant pain associated with fatty meal intolerance for one month. The pain was relieved by antispasmodics. Her liver function test was normal. Ultrasonogram of abdomen revealed, thick wall gall bladder with solitary stone in the gall bladder. Retrograde subtotal cholecystectomy was done. The histopathology report of the gall bladder revealed granulomatous cholecystitis suggestive of tuberculosis. Keywords: Gall bladder, Tuberculosis, , Granulomatous cholecystitisPublication Malignant teratoid medulloepithelioma in eye(2003) Pradhan, SB; Adhikari, RC; Shrestha, B; Sayami, G; Dali, S; Shrestha, HGNA.Publication Pattern of Renal Cell Carcinoma – A Single Center Experience in Nepal(Kathmandu University, 2011) Sidharth; Luitel, BR; Gupta, DK; Maskey, P; Chalise, PR; Sharma, UK; Gyawali, PR; Shrestha, GK; Sayami, G; Joshi, BRABSTRACT Background Renal tumor is the 13th most common malignancy in the world and more than 90% of renal tumors are renal cell carcinomas. As there is no data available on renal cell carcinoma in Nepal, hence this study was undertaken to analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Objectives To analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Methods The case records of 50 consecutive patients with renal cell carcinoma presenting at the Tribhuvan University Teaching Hospital, Kathmandu from July 2006 to June 2011 were retrospectively evaluated for presenting symptoms, physical finding, investigation and histopathology report. Results Out of 50 patients, 64% were male and 36% were female. The age ranged between 11 to 78 years (mean ± SD: 55 ± 15 years). Fifty four percent of patients were smokers. Incidentally tumor was detected in 40% cases by ultrasonography and the typical triad was present in only 4%. The tumor was occupying upper pole in 40% of cases. The tumor size ranged from 3 to 15 cm (mean ± SD: 7.3 ± 2.9 cm). Histopathologically, 76% of the patient had organ confined renal cell carcinoma (T1- 2 N0 M0). Clear cell was the most common type seen in 86%. Fuhrman’s nuclear grade 2 was found in 50%. Conclusion Many of the renal cell carcinoma are detected incidentally, at an early stage and are of clear cell subtype. KEY WORDS Incidental renal tumor, Nepal, Renal cell carcinoma.Publication Small Cell Carcinoma of Ethmoid Sinus(Institute of Medicine, 2009) Adhikari, P; Bhatta, R; Pradhan, B; Thapa, N; Bhandari, R; Karki, R; Shrestha, A; Sayami, GAbstract Extrapulmonary small cell carcinoma is a rare entity. Here, we report a case of small cell carcinoma of left ethmoid sinus, in a 32 years old female. She underwent left medial maxillectomy and excision of the mass via lateral rhinotomy approach with post operative chemoradiation.Publication Study of effusion cytology in patients with simultaneous malignancy and ascites(Kathmandu University, 2006) Jha, R; Shrestha, HG; Sayami, G; Pradhan, SBObjective: To evaluate sensitivity of effusion cytology in detecting malignancy Materials and methods: Effusion cytology was studied from 37 malignancy associated and 28 non malignancy associated ascitic fluid samples. Results: Out of 65 cases, 44 (67.7%) effusions were reported negative, 15 (23.1%) were positive and 6 (9.2%) were suspicious for malignancy. Thus total 21 effusions (32.3%) were tumour cell positive. All 21 (100%) were true positive, none (0%) was false positive, 28 (63.6%) were true negative and 16 (36.4%) were false negative. Thus ascitic fluid cytology had sensitivity of 56.7% and specificity of 100%. Predictive value of positive test and negative test was 100% and 63.6% respectively. Stomach was the most common primary site of malignancy associated with ascites (11 /37 i.e. 29.7%) where as adenocarcinoma was the most common type of malignancy (11/15 i.e.73.3%) in ascitic fluid cytology. Conclusion: Ascitic fluid cytology is a simple and useful procedure with sensitivity of 56.7% and should be routinely requested. Key words: Ascitic fluid, Effusion cytologyPublication Surgical Management of Primary Hyperparathyroidism: An Institutional Study on Surgical Quality Control(Institute of Medicine, 2017) Nepal, B; Singh, YP; Pokhrel, A; Sayami, P; Sayami, GAbstract Introduction: Surgery is key treatment of primary hyperparathyroidism. With the inclusion of serum calcium measurement in routine biochemistry panel, majority of primary hyperparathyroidism can be detected in earlier asymptomatic phase. Preoperative localization by Ultrasonography and Sestamibi scan combined together along with CT or MRI in ectopic adenoma enables for focused minimal invasive surgery. Intraoperative intact PTH (IPTH) measurement is used as a surgical quality control in primary hyperparathyroidism surgery. This study was undertaken to look into current status of surgical management of primary hyperparathyroidism in the tertiary care center in Nepal. Methods: This was a prospective observational study conducted in Department of Surgery. Tribhuvan University Teaching Hospital Kathmandu, Nepal from November 2014 to October 2016. Demography profile, preoperative symptoms, duration of symptoms, preoperative serum calcium, phosphate, immediate preoperative iPTH level and intraoperative iPTH level, post-operative calcium level and localization techniques were recorded. Final pathology report of each of the patients were recorded. Results: Thirteen patients were operated for primary hyperthyroidism. Mean age of the patients was 36:15 years. None of the patient had multi-glandular disease on preoperative localization. Mean preoperative Calcium level was 12.8±0.9 mg/dl and mean preoperative iPTH level was 998+805 pg ml. As Intraoperative iPTH measurement was used to ascertain the successful adenoma removal, mean IPTH intraoperative iPTH after the removal of the adenoma was 175±167 pg/ml. Mean difference of iPTH was 823±725 (p 0.024). There was mean decrease of 81% of iPTH after surgery well above 50% decrease confirmatory of successful adenoma removal. None of patients had reported with recurrent symptoms till date. Conclusion: Hypercalcemia should be subjected for iPTH scanning to identify more asymptomatic patients and Surgery is key treatment and intraoperative iPTH assay is used for confirmation of adenoma removal. Keywords: Hypercalcemia, Primary Hyperprathyroidism, Focused Parathyroidectomy, iPTH monitoringPublication The Role of Argyrophilic Nucleolar Organizer Region (AgNOR) Study in Cytological Evaluation of Fluids, Especially for Detection of Malignancy(Kathmandu University, 2012) Karki, S; Jha, A; Sayami, GABSTRACT Background Serous effusion smears reported as “suspicious for malignancy” pose problems in clinical management. Silver staining for argyrophilic nucleolar organizer regions (AgNOR) has proved useful in making a cytopathologic differential diagnosis between benign and malignant cells. Nucleolar organizer regions(NORs) are loops of DNA located in acrocentric chromosomes. These NORs are visualized by silver staining technique that recognizes these argyrophilia associated proteins which are increased in malignancy. Objective This study aimed to distinguish reactive mesothelial cells from malignant cells in serous effusions using these NORs. Methods A total of 174 serous effusions received at the Department of Pathology, TUTH, during a period of one year were included in the study. Smears were studied by conventional Papanicolaou and Giemsa stains. AgNOR counts, variation in size and dispersion of AgNOR dots in smears were graded and compared in malignant and non-malignant effusions. Results Mean AgNOR counts of 10.43±0.73 and 10.21±0.51 in malignant peritoneal and pleural effusions, respectively, were significantly (p<0.0001) greater as compared with counts of 2.12±0.54 and 2.11±0.54 in non-malignant effusions. The AgNORs were irregular in shape in malignant effusions whereas they were comparatively larger, single dots in benign effusions. AgNOR size and dispersion were of higher grade in significantly greater proportion of malignant as compared with non malignant effusions (p<0.0001). Of the cytologically suspicious samples, nine were in the malignant range and one was in the benign range. Conclusion AgNOR study appears to be clinically useful as an additional diagnostic tool for use in serous effusion when the cytologic diagnosis is difficult. KEY WORDS AgNOR , cytology, effusions