Publications by authors named "Manish Kiran Shrestha"

8 Publications

  • Page 1 of 1

Extra-gastrointestinal stromal tumor presenting as a huge peritoneal mass and mimicking as mesothelioma - A case report.

Int J Surg Case Rep 2021 Jan 26;78:351-355. Epub 2020 Dec 26.

Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal.

Introduction And Importance: Extra-gastrointestinal stromal tumors are group of soft tissue neoplasm, which originates outside the gastrointestinal tract comprising of less than 5% of the total gastrointestinal stromal tumors.

Case Presentation: A 67 years old male came with a history of vague abdominal pain, discomfort and loss of appetite. Per abdominal examination showed a palpable firm mass which was filling both the flanks. Radiological imaging revealed a large abdomino-pelvic mass with central necrotic areas. Exploratory laparotomy was done and the mass was excised intact from the sigmoid mesocolon. Histopathological diagnosis was given as extra-gastrointestinal stromal tumors.

Clinical Discussion: Extra-gastrointestinal stromal tumor was first described by Miettinen et al. in 1999. The tumor can arise from the pleura, omentum, mesentery, retroperitoneum and prostate. The clinical presentation of the tumor depends on its location and the size of tumor. Patients with these tumors present with abdominal pain, followed by abdominal mass and distention. These tumors show pathological, immunohistochemical and molecular biological characters similar as that of gastrointestinal stromal tumor.

Conclusion: Extra-gastrointestinal stromal tumor is a rare tumor and can reach to a considerable large size before presenting with clinical symptoms especially if the tumor arises from the mesocolon. IHC study plays an important role to reach to the final diagnosis as the tumor can mimic mesothelioma in routine staining.
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http://dx.doi.org/10.1016/j.ijscr.2020.12.069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787961PMC
January 2021

Recurrence of ruptured intracranial epidermoid cyst - A rare case report and presentation.

Int J Surg Case Rep 2020 1;76:310-314. Epub 2020 Oct 1.

Department of Pathology, Manipal College of Medical Sciences, Pokhara, Nepal.

Introduction: Intracranial epidermoid cysts are congenital tumors that develop from ectodermal remnants during neuroembryogenesis between the third and fifth weeks of gestation. These tumors are benign and usually present with local mass effect. Here, we present a rare case of ruptured intracranial epidermoid cyst with recurrence.

Presentation Of Case: A 55 years old male patient was brought to emergency with a history of headache and loss of consciousness for 1 h. Radiological imaging showed the features suggestive of ruptured intracranial epidermoid cyst which was operated. Two years later the patient re-presented with headache for 4-5 days where repeat MRI revealed recurrence of the tumor.

Discussion: Epidermoid cysts are very slow growing tumor at a linear rate due progressive accumulation of normally dividing epidermal cells. These tumors often reach a large size before the onset of symptoms. At times, the tumor capsule may show infiltration to the brain parenchyma and tight adherence to neurovascular structures which leads to the incomplete removal of the tumor capsule leading to recurrence of tumor.

Conclusion: Rupture of intracranial epidermoid cyst is a rare phenomenon and recurrence of this tumor in patients is even infrequent.
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http://dx.doi.org/10.1016/j.ijscr.2020.09.161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7567175PMC
October 2020

Sensitivity of Sinus Radiography Compared to Computed Tomogram: A Descriptive Cross-sectional Study from Western Region of Nepal.

JNMA J Nepal Med Assoc 2020 Apr 30;58(224):214-217. Epub 2020 Apr 30.

Department of Pathology, Manipal College of Medical Science, Pokhara, Nepal.

Introduction: Radiography of the paranasal sinuses is commonly used diagnostic modality. However, the trustworthiness of plain radiographic findings of paranasal sinuses is debatable. The intention of this study was to weigh the diagnostic soundness of plain radiograph of the paranasal sinuses to that of computed tomogram scan.

Methods: This is a descriptive cross sectional study carried out in 110 participants in Department of Radiology of Gandaki Medical College from November 2017 to April 2018. Ethical approval is obtained from Institution review board (Ref. No.39/074/075). Sample size was calculated taking confidence level of 95%, expected prevalence of 14% and precision of 6.5% in population of 492098 in Province 4 of Nepal. Random sampling method was used. Data was enter in Statistical Package for the Social Sciences version 17 software and analysed.

Results: A total of 110 participants are included in this study of which 62 (56.4%) are females and 48 (43.6%) are males with an overall mean age of 34.5 years. The commonly involved sinus was maxillary 56 (50.9%) followed by ethmoid 33 (30%) sinus. The overall sensitivity and specificity of detecting sinusitis by sinus radiography is higher for maxillary sinus (89.7% and 87%) followed by ethmoid (69.7% and 96.1%) and frontal (61.5% and 96.9%) sinuses.

Conclusions: Sinus radiography is more sensitive for detecting pathologies in maxillary sinuses, while it is moderate for frontal, ethmoid sinuses and least for sphenoid sinuses. Diagnostic accuracy of computed tomogram scan is more, hence should be recommended to characterize the complex pathology and anatomy of the osteomeatal complex.
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http://dx.doi.org/10.31729/jnma.4824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580457PMC
April 2020

Delayed Presentation of Renal Arterio-Venous Fistula and Pseudoaneurysm in Native Left Kidney in Allograft Recipient: A Case Report.

JNMA J Nepal Med Assoc 2019 Jul-Aug;57(218):272-274

Department of Interventional Radiology, Sir Ganga Ram Hospital, Rajinder Nagar, Delhi, India.

Iatrogenic complications due to renal biopsy majorly include formation of an arterio-venous fistula, pseudoaneurysm or arterio-ureteral fistula. These complications are observed within a span of few days post biopsy and are rare after few years. We reported a case of 32-year-old renal allograft recipient male presenting 6 years post biopsy of the left kidney with left lumbar region pain who was eventually diagnosed with arterio-venous fistula and pseudoaneurysm involving inferior interlobular branch of left renal artery. Superselective embolization was achieved using coils and high concentration glue and transient placement of a venous occlusion balloon with complete technical and clinical success. Keywords: renal arterio-venous fistula; renal biopsy; renal pseudoaneurysm.
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July 2020

Squamous cell carcinoma arising in familial gingival fibromatosis-a rare case report.

J Surg Case Rep 2017 Oct 9;2017(10):rjx197. Epub 2017 Oct 9.

Department of Pathology, Manipal College of Medical Sciences, Nepal.

Familial gingival fibromatosis is a rare hereditary condition due to chromosomal abnormality which can occur as an isolated disease or as part of a syndrome and has an incidence of 1:350 000. This condition leads to esthetic, functional, psychological and masticatory disturbance of the oral cavity. Here, we present a case of 21-year-old female with severe enlargement of gums in maxilla and mandible. Deciduous teeth were erupted at normal age but the permanent teeth in the oral cavity were not erupted. Her grandmother, father and younger sister were also affected with the same condition. Incisional biopsy from the chronic ulcerated gingiva showed squamous cell carcinoma. Patient was referred to other cancer institution, where metastases to lung, bone and lymph node was detected on CT scan. The diagnosis was made based on clinical examination, family history and histopathological examination.
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http://dx.doi.org/10.1093/jscr/rjx197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633648PMC
October 2017

Diffuse vascular malformation of large intestine clinically and radiologically misdiagnosed as ulcerative colitis.

J Surg Case Rep 2017 Feb 15;2017(2):rjx016. Epub 2017 Feb 15.

Department of Pathology, Manipal College of Medical Sciences, Pokhara 61, Nepal.

Hemangiomas and vascular malformations of the gastrointestinal tract are rare clinical entities that usually present as overt or occult bleeding. They can be distributed throughout the gastrointestinal system, or present as a singular cavernous hemangioma. Overall, 80% of such malformations are of cavernous subtype and are misdiagnosed as hemorrhoids and ulcerative colitis. Mucosal edema, nodularity and vascular congestion can lead to the incorrect diagnosis of inflammatory bowel disease. We present a case of 26-year-old male who presented with pain abdomen, bleeding per rectum and was treated as a case of ulcerative colitis for past 12 years on the basis of clinical and radiological features. As the patient did not respond, subtotal colectomy was done which on histopathologically reported as cavernous vascular malformation-diffuse infiltrating (expansive type).
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http://dx.doi.org/10.1093/jscr/rjx016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400486PMC
February 2017

14 years hospital based study on clinical and morphological spectrum of hydatid disease.

JNMA J Nepal Med Assoc 2013 Apr-Jun;52(190):349-53

Department of Community Medicine, Manipal College of Medical Sciences, Pokhara, Kaski, Nepal.

Introduction: Hydatid disease is endemic in sheep and cattle-raising areas worldwide. Its prevalence is high in Nepal. The study was carried out to determine the clinical, radiological and pathological presentations of hydatid disease.

Methods: This was a retrospective study of all hydatid disease cases reported in Department of Pathology, from August 1996 to July 2010. All the clinical, radiological and pathological data were collected and collated.

Results: A total of 51 cases of hydatidosis were studied. Patients presented with related symptoms in 47 cases, 92.16% with CI (84.78, 99.54) and asymptomatic in four cases, 7.84% with CI (0.46, 15.22). Involvement of liver and lung was found in 35 (68.63%) cases and 10 (19.61%) cases respectively. Involvement of other organs like kidney, pelvis and broad ligament were seen in 6 of the cases. Total 29 cases, 56.86% with CI (43.2, 70.46) had solitary cyst while rest of the cases had multiloculated cyst. All cases had radiological correlation and histopathological confirmation.

Conclusions: Most cases presented with organ related vague symptoms, however it should be considered as a differential diagnosis especially in asymptomatic cases and cases with unusual sites. Imaging studies is useful in preoperative diagnosis and postoperative histopathology is confirmatory. A multicentric hospital based study will help to decrease the incidence.
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July 2014

Value of image-guided fine-needle aspiration cytology-a study of 500 cases.

Diagn Cytopathol 2013 Dec 25;41(12):1052-62. Epub 2012 Sep 25.

Department of Pathology, Manipal Teaching Hospital, Manipal College of Medical Sciences, Kathmandu University, Nepal.

Guided Fine-Needle Aspiration Cytology (FNAC) as the first line investigation is not only useful in diagnosis of space occupying lesions but can also help in choosing appropriate management. This technique is most useful in diagnosing metastasis but is also helpful in excluding malignancy in some cases. Aim of this study is to analyze the spectrum of cytological diagnosis, adequacy, and clinicoradiological correlation of guided FNAC. The study was carried out in the departments of pathology and radiology for a period from January 2000 to November 2011. All the data were retrieved from hospital medical record section and departmental data bank and were analyzed. We have performed a total of 500 FNACs, including 234 under CT guidance and 266 under USG guidance. Among the CT-guided FNACs, 87.6% (205 cases) had adequate material which included 152 malignant cases, 38 inflammatory cases and 15 benign cases. Among the cases under USG, 91.7% (244 cases) had adequate material comprising of 112 malignant cases, 44 inflammatory cases, and 88 benign lesions. It was noted that increased number of inadequate aspirate was from lesions with smaller size and increased depth. Out of total 264 malignant cases diagnosed on FNAC, 160 cases were identified as malignant on clinical and radiological findings. Guided FNAC is useful in deep seated lesions as well as in suspicious superficial lesions and is a safe diagnostic tool. If performed properly and correlated well with clinical and radiological findings, FNAC provides correct diagnosis in most cases.
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http://dx.doi.org/10.1002/dc.22922DOI Listing
December 2013