Background: Breast carcinoma is the most frequent malignant tumor in women accounting for approximately 15% of female cancer deaths. It is the second most common malignancy among women in Nepal. Our objectives were to study the extent and spread of different histological types breast carcinoma in the eastern region of Nepal, to grade and stage the tumors, score the prognosis. Materials and methods: A cross-sectional descriptive study of mastectomy specimens with axillary lymph node sampling was done for a period of two years. Diagnosis was done using WHO classification. Modified Bloom Richardson score and TNM system was used to grade and stage the tumors. NottinghamPrognostic index was applied to score the prognosis. Results: Out of 31 total cases, the most common histologic type was Invasive Carcinoma of No Special Type (67.74%). The largest tumor size was of 12cm which had poor NPI score. Most tumors were of grade II and T2. Out of 30 cases with lymph nodes, 13 were negative for metastasis pN0, 10 were pN1 and 7 were pN2. Extranodal spread was observed in 6 out of 17 cases with lymph node metastasis and was associated with higher grades and poor prognosis. Conclusion: Higher grade tumors, lymph node metastasis and extranodal extension are associated with higher Nottingham Prognostic Index score.

Background: Megakaryocyte morphology plays an important role in thrombopoiesis. A defect in any stage of megakaryocytopoiesis can lead to dysmegakaryocytopoiesis and thrombocytopenia. This study was conducted to understand megakaryocytic alterations and their contribution in the diagnosis of cases of thrombocytopenia.Materials and Methods: This was a cross-sectional study was conducted on all consecutive cases of bone marrow aspirates of thrombocytopenia over a duration of one year in BPKIHS. Megakaryocyte morphology was studied with a 100X objective. Data were entered into Microsoft excel 10 and analysed with SPSS version 11.5. Descriptive statistics charted and Chi-square tests were done for inferential statistics to find any association at 95% Confidence Interval.Results: Among the 38 subjects, megakaryocytic thrombocytopenia (44.7%) was the most common cause of thrombocytopenia.  Hypolobated megakaryocytes (63.2%), bare megakaryocytic nuclei (57.9%) were the common morphological changes in megakaryocytes. Odds of increased megakaryocyte count in megakaryocytic thrombocytopenia was found to be 12.5 times than for other causes of thrombocytopenia and the presence of bare megakaryocytic nuclei in MTP was statistically significant. (p –value<0.05)Conclusion: Many similarities were observed in megakaryocytic morphology among different hematological diseases. However, increased megakaryocyte count and presence of bare megakaryocytic nuclei, hypolobated forms were significant in megakaryocytic thrombocytopenia.

Hepatocellular carcinoma (HCC) is the most frequent primary malignant tumor of the liver. Chronic hepatitis B infection is the most common cause of HCC. Bony metastasis of HCC is usually rare, in which the most common sites involved are vertebra, pelvis, rib and skull. Still rarer are metastasis to the chest wall. Metastatic HCC has an aggressive course and poor prognosis. Hereby, we report an unusual case of HCC metastasis which presented initially as swelling of the anterolateral aspect of the chest wall. DOI: http://dx.doi.org/10.3126/njms.v1i2.6616 Nepal Journal of Medical Sciences. 2012;1(2): 138-40

Background: Sinonasal lymphomas are the commonest nonepithelial malignancies of the nasal cavity and paranasal sinuses. They may spread from their site of origin in nasal cavity and invade adjacent structures including orbits leading to varying presentation and a diagnostic dilemma. Case: A-77-year old Nepalese male presented with swelling of left eye since 1 month and pain in the same eye since 2 days. Observation: Examination revealed axial proptosis, swelling of lids, restricted extraocular movement, diffuse conjunctival and ciliary congestion with chemosis. Visual acuity was grossly decreased. The case was diagnosed as left orbital cellulitis and treated with broad spectrum intravenous antibiotics and oral steriods. There was no response despite 3 days of antibiotics and steroids therefore a computed tomography was planned which showed features of Sinonasal malignancy invading the orbit. Repeated biopsy was suggestive of malignant small round cell tumour. In the view of unclear preoperative biopsy indicating further details on the histologic type of tumor and extensive erosion of maxilla with complete loss of vision in the eye the patient was planned for Total Maxillectomy with Orbital extenteration of the left orbit. Post-operative histopathological and Immunohistochemical report were suggestive of High grade Lymphoma. The patient was advised for Adjuvant Chemotherapy and Radiotherapy, which the patient refused due to financial constraints. He is on occasional follow up since the last 6 months. Conclusions: The diagnosis of maxillary sinus lymphoma needs to be borne in mind when a clinician encounters a case of Orbital Cellulitis. It may be difficult to diagnose clinically and require radio-pathological correlation.

Penile tuberculosis is an extremely rare form of genitourinary tract tuberculosis even in developing countries with higher tuberculosis prevalence. A 38-year-old married male without promiscuous behavior presented to dermatology outpatient department with a single, painful penile ulcer of 1.5×1cm size for last 2 years; which got mildly improved after on and off treatment from local practitioner, but without complete resolution. All workup in the line of sexually transmitted diseases were negative. Incisional biopsy revealed diffuse granuloma, however stain for AFB (TB) was negative. He also had positive mantoux test and raised ESR. On these bases, we started him on category I-anti tuberculosis therapy; which resulted into complete resolution of ulcer leaving behind fibrotic scar. Hence, in country like Nepal where the prevalence of tuberculosis is high, we should always suspect tuberculosis in case of non-healing chronic ulcers.