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Background: Transvaginal ultrasonography has increased the reliability of imaging diagnosis of women with endometrial pathologies and this technique has become widely used to evaluate endometrial thickness in women with postmenopausal bleeding. Materials and methods: 359 women presenting with history of at least three months amenorrhea were undergone transvaginal ultrasonography with measurement of endometrial thickness and uterine size. Endometrial biopsies were taken in 69 cases (19.2%) only. Results: The median age of patients was 53 years with the age range of 42 years to 81 years. Abdominal pain was the commonest symptoms followed by backache. 3/69 cases with histopathological diagnoses had normal sized uterus, while 66 cases had bulky (>6.0 cm) uterus. 58/69 cases showed > 5 mm thick endometrium and the endometrium was abnormal in 31/69 cases. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography to detect abnormal endometrium were 91.2%, 22.9%, 53.4% and 72.7% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of transvaginal ultrasonography to detect endometrial hyperplasia and carcinoma were 100%, 17.5%, 10.3% and 100% respectively. Conclusions: Transvaginal sonographic evaluation of endometrial thickness and uterine size is useful for exclusion of endometrial pathology and to avoid unnecessary invasive surgical procedures.

Background: Tumours and tumour like lesions of the colon and rectum have overlapping clinical presentation and may be difficult to diagnose on clinical grounds alone. Histopathological examination although helpful to arrive at correct diagnosis, at times may be difficult and may require ancillary tests such as immunohistochemistry. Materials and Methods: A prospective cross sectional study enrolled 125 cases of colorectal biopsies after histopathological confirmation of tumours and tumour like lesions. The specimens were received at the Department of Pathology, of TUTH, from December 1, 2015 to November 30, 2016. Results: Out of 125 cases, 32 cases were benign tumours, 36 cases were malignant tumours and 57 cases were tumour like lesions. Most common age range was 51-60 years with mean age of 38 years. Males comprised 76.74% and females 23.26% with ratio of 3:1. Juvenile polyp was the commonest lesion. Among benign tumours, tubular adenoma was the most common (19.2%), adenocarcinoma was most common malignant tumour (25.6%) and juvenile polyp was the most common tumour like lesion (27.2%). Left side was most common side (66.67%) and rectum was the most common site (48.8%). Conclusions: The commonest indications for colorectal biopsies were tumours and tumour like lesions. Juvenile polyp was the most common tumour like lesion, tubular adenoma was the most common benign tumour and adenocarcinoma was the most common malignant tumour. Histopathological examination is a gold standard for confirmation of all tumour and tumours like lesions of colon and rectum.

Background: The skin is a heterogeneous organ, capable of producing various types of skin tumors. The incidence of skin cancers, including melanoma and non-melanoma has been reported to have risen in many parts of the world. In Asian and African countries, individuals with pigmented races have a much lower incidence of skin cancers despite sunny hot weather. This study is aimed to analyze age, sex and site wise of distribution of skin cancers. Materials and Methods: The study included a total of 60 patients with histopathologically proven skin cancers from January 2015 to December 2018 in the department of pathology, DI skin health and referral centre, Kathmandu, Nepal. Results: A total of 60 cases of histopathologically proven skin cancer constituted 3.69% of total skin biopsies. Patient age ranged from 15 to 88 years with mean age being 61 years. The majority of the patients were in the age group of 61-70 yrs. The male to female ratio is 1:1.3. Basal cell carcinoma was the most common skin cancer constituting 43.4%, followed by squamous cell carcinoma (28.3%). The most common site of skin cancer is head & neck (73.3%), followed by lower extremities (8.3%). Other skin cancers were Bowen’s disease, melanoma, verrucous carcinoma, keratoacanthoma, trichilemmal carcinoma, extramammary Paget’s disease, Non-Hodgkin lymphoma and metastatic tumor. Conclusions: The most common type of skin cancer is basal cell carcinoma, followed by squamous cell carcinoma and head & neck being the commonest site.

Background: Cutaneous granulomas comprise a wide spectrum of diseases that are frequently encountered. Since clinical assessment alone is insufficient in most of the cases, skin biopsies are a basic requisite in evaluating these lesions. Histopathological examination, although helpful in deciding the nature of granulomas and etiology in most of the cases, maybe noncontributory in some cases, thus requiring further ancillary tests such as microbial culture, polymerase chain reaction. Materials and Methods: This prospective cross sectional study enrolled 109 cases of skin biopsies after histopathological confirmation of granulomatous lesions. The specimens were received at the Department of Pathology from 14th April 2017 to 13th April 2018. Results: Out of 650 skin biopsies, 109 cases (16.8%) were diagnosed as granulomatous lesions on histology. Male predilection was noted and age group of 31 to 40 years was the commonest affected. Upper extremities were more commonly involved. Leprosy was the commonest etiological agent and tuberculoid granulomas were the commonest type based on their histology. Conclusions: Leprosy was the most common cause of cutaneous granuloma followed by Tuberculosis, fungal infection and foreign body reaction. Among the cases of leprosy, borderline tuberculoid leprosy and tuberculoid leprosy were the commonest subtype.

Background: Skin diseases are very much prevalent in the developing countries. The pattern of skin diseases varies from country to country and even region to region within a country. The histological diagnosis is used by clinicians to aid in the management of patients & most appropriate clinical interventions. Materials and methods: The study included a total of 1040 skin biopsies from January 2016 to December 2018 in the department of pathology, DI skin health and referral centre, Kathmandu, Nepal. Results: The majority of the patients were in the age group of 31-40 years. The most common skin disease is non-infectious vesicobullous and vesicopustular disease (28.6%), followed by non-infectious erythematous papular and squamous disease (25.9%). The most common vesicobullous disease is spongiotic dermatitis (84.8%). Erythema dyschromicum perstans (31.8%) is the commonest non-infectious erythematous papular and squamous disease. The most common microbial disease is fungal infection, followed by leprosy. Among the neoplastic diseases of skin, tumors of epidermis are commonest diseases and the most common epidermal tumor is basal cell carcinoma. The commonest tumor of skin is melanocytic nevus. The most frequent site is upper extremities. Conclusions: Eczema is predominating non-infectious vesicobullous and vesicopustular disease. A relatively higher, prevalence of fungal infections was observed. Basal cell carcinoma is the commonest epidermal tumor and melanocytic nevus is commonest of all skin tumors.

Miescher’s cheilitis is an inflammatory disorder characterized by chronic lip swelling due to granulomatous inflammation. It is rare disorder first described by Miescher in 1945. It is monosymptomatic form of Melkersson-Rosenthal syndrome. We report a case of Miescher’s cheilitis in a 59-year old lady presented with recurrent swelling and erythema of upper lip and submental area with no features of facial palsy and fissuring of tongue. Laboratory tests including serum complement C3, C4 and C1 esterase inhibitor functional were within normal limits. The biopsy from the upper lip revealed dermal edema, dilated lymphatic channels and multiple granulomas. After exclusion of other causes of orofacial granulomatosis, the diagnosis of Miescher’s cheilitis was made. Patient was treated with oral hydroxychloroquine and topical tacrolimus and mometasone cream with gradual improvement.

Granular cell tumor is a rare benign neoplasm of the skin that accounts for 0.5% of all soft-tissue tumors. Granular cell tumor can affect both sexes and in any age, although it is most common in females. The common locations are the head and neck, the tongue is affected in 25% of cases but any internal organs can be affected such as soft tissue, bronchus, stomach, rectum, anus, biliary ducts. Here, we report a 58-year-old female patient who presented with a 4-year history of a slowly growing mass, with a dimension of 5 × 4 cm on her left waist, diagnosed as a Granular cell tumor at histopathological examination.

Histoplasmosis is a fungal infection caused by a dimorphic, saprophytic fungus Histoplasma capsulatum with primary predilection for the lungs and disseminated infections occurring rarely. Our case illustrates the case of disseminated adrenal histoplasmosis in an immunocompromised 42-year-old diabetic man. Radiological diagnosis suggested bilateral malignant adrenal mass, most likely metastasis. FNAC yielded blood only. Excisional biopsy from left adrenal gland, Hematoxylin & Eosin staining along with special stains as Periodic Acid Schiff and Grocott’s Methenamine Silver were performed to yield the concluding diagnosis of histoplasmosis.

ABSTRACTLeishmaniasis is considered to be zoonotic disease, caused by a protozoan parasite of the genus Leishmania, and transmitted by a bite of infected female sandfly. Primary cutaneous leishmaniasis is not common disease in Nepal, however, there were cases reported from Terai region of Nepal. The patients with cutaneous leishmaniasis present with a papule or nodule at the site of inoculation, followed by formation of crusts. Differential diagnoses of cutaneous leishmaniasis include variety of skin diseases, inflammatory like impetigo, eczema, or granulomatous like sarcoidosis, lupus vulgaris, to skin tumor like basal cell carcinoma & squamous cell carcinoma. There are various procedures and laboratory techniques used to diagnose leishmaniasis. Punch skin biopsy is widely used & popular technique to diagnose cutaneous leishmaniasis. Different drugs like sodium stibogluconate, sodium antimony gluconate, Amphotericin B and Miltefosine: are used for its treatment. No vaccines are available for prevention.