Reena Rana’s research while affiliated with Nepal Police Hospital and other places

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Publications (6)


Figure 1 A. Preoperative MRI brain revealing a hyperintense lesion on T2-weighted image on axial plane measuring 4.2 cm × 4.0cm × 1.4cm. B. Postoperative MRI brain revealing heterogenous collection at tumor resection bed in right lateral aspect of posterior fossa where central component of the collection displays mixed signal.
Figure 2. A. Gross image appeared greyish white to greyish brown nodular tissue. B. Cut section showed solid to cystic area. Microscopic examination revealed tumor tissue predominantly composed of cribriform growth pattern with nest of tumor cells with discrete, rounded punched out gland like spaces filled with eosinophilic to basophilic material (Figure 3A). Area of tubular pattern with multiple ducts and tubules like structure are lined by small uniform cuboidal epithelium (Figure 3B). A focus of solid sheets of tumor cells (<30% solid component) noted. Infiltrating tumor nests are identified within fibrous stroma. Perineural invasion is evident. Focal areas of reactive gliosis with dilated and congested blood vessels are noted.
Figure 3. A.Tumor tissue predominantly composed of cribriform growth pattern with nest of tumor cells with discrete, rounded punched out gland like spaces filled with eosinophilic to basophilic material (Hematoxylin and Eosin stain x10). B. Area of tubular pattern with multiple ducts and tubules like structure are lined by small uniform cuboidal epithelium (Hematoxylin and Eosin stain x40).
Figure 3. A. The tumor cells expressed CD117 positivity in luminal layer. B and C.The tumor cells expressed P40 and CK7 in myoepithelial layer. D. Ki-67 was nearly 12%
Primary Intracranial Adenoid Cystic Carcinoma: A Case Report
  • Article
  • Full-text available

January 2025

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1 Read

JNMA; journal of the Nepal Medical Association

Pralisha Maharjan

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Reena Rana

Adenoid cystic carcinoma (ACC) is a rare slow-growing but aggressive malignant tumor arising from the epithelial cells of mucous-secreting glands. Primary intracranial ACC is one of the rarest entity. We report a case of a 61 years old male presenting with difficulty in swallowing, slurring of speech, generalized body weakness. Patient had residual right cerebellopontine angle (CPA) mass causing midline shift and fourth ventricular obstruction on MRI. Patient underwent right retrosigmoid craniotomy with excision of CPA mass. Histopathological examination confirmed the case as primary intracranial ACC.

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Figure 1. Age distribution of study patients.
Figure 2. Status of positive and negative cases among patients.
Retrospective study of correlation between high risk detection of HPV and liquid based cervical cytology for cervical cancer screening

December 2024

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3 Reads

Nepal Mediciti Medical Journal

BACKGROUND Cervical cancer is most common in Nepalese women. Human papilloma virus (HPV) plays a main role in pathogenesis of cervical cancer. Human papilloma virus serotype 16 is the most common type followed by HPV 18. Liquid based smear cytology (LBC) is a simple, safe, non-invasive and cost effective method for the detection of squamous intraepithelial lesion or squamous cell carcinoma. The aim of this study was to correlate HPV DNA testing result with the findings of Liquid based cytology. METHODS This was a retrospective study conducted for 2 years at Department of Laboratory Medicine Pathology, Nepal Mediciti hospital from 1st may 2021 to 30th April 2023. Total of 1456 cases were included in this study. RESULTS Out of 1456 cases, 100 cases were positive for HPV. The concordance between HPV DNA test and LBC findings is 57%. The highest HPV-positive cases were seen in the age group of 31-40years. The most common HPV genotype study was HPV 16 (28%) followed by HPV 18 (27%). HPV 16 was positive in 57% of ASCUS positive cases of LBC, is statistically significant (P value-0.017). HPV 18 was positive in 37.0% of ASCUS positive cases of LBC, is not statistically significant (P value-0.018). The concordance between HPV positive detection and LBC findings is 57% and discordance is 43%. CONCLUSIONS This study shows the prevalence of HPV is higher in middle to young age group. ASCUS was common finding in LBC in HPV positive cases followed by LSIL,HSIL and SCC. However 43% of HPV positive cases were reported as negative for intraepithelial lesion (NILM) as there was no abnormality in squamous epithelial cells. Both the HPV test and cervical LBC smears are valuable tools for early detection of cervical precursor lesion. However, neither test alone provides conclusive results for comprehensive screening. So, it is recommended to use both test in combination for more accurate and reliable findings in cervical cancer screening.


Castleman disease: A single-center case series in Nepal Mediciti Hospital

December 2024

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2 Reads

Nepal Mediciti Medical Journal

Shoshan Acharya

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Sunila Basnet

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[...]

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Nikki Thakur

BACKGROUND In 1954, Castleman Disease (CD), was first described and is also known as angiofollicular lymph node hyperplasia or giant lymph node hyperplasia . Among many sites where lesion occurs, commonest is in the thorax (60%), abdomen (11%), neck (14%), and axilla (4%) MATERIALS AND METHOD We analyzed five cases of Castleman disease we received in Nepal Mediciti during five-year period from 2020 to 2024. Demographics, clinical variables, anatomical site, centricity, histopathology, immunochemistry, and surgical approach were reviewed. RESULTS Among five cases, anatomical location of two cases from retroperitoneum, two from inguinal region and one is from cervical lymph node. Three cases were male and two were female. Age group of these five cases shows three were adult and two were children. All of them underwent surgical resection and under continuous follow up. One of the cases from retroperitoneum had got recurrence. CONCLUSION Castleman disease is a diagnosis of exclusion. Case should be evaluated on the basis of proper clinical findings, blood parameters, HIV and HHV-8 test, imaging along with biopsy and IHC. Lymphoma and Kaposi sarcoma may mimic on radiology and histologically with Castleman disease.


A rare case of combined ileal lipoma and heterotopic gastric mucosa as the leading pathological point for adult ileo-ileal intussusception

December 2024

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7 Reads

Nepal Mediciti Medical Journal

Intussusception is defined as telescoping of one segment of bowel into another one. It is an uncommon cause of intestinal obstruction in adults with a reported incidence of 1 in 1300 abdominal cases presenting as obstruction. Intussusception as a cause of intestinal obstruction in adults is rare. There is invariably an underlying pathology which leads to intussusception in adults, some of the main causes of this are carcinomas, polyps, strictures, benign tumors, Meckel’s diverticulum, and colonic diverticulum. Here we present a case of intussusception which had a subserosal lipoma as a lead pathological point, but the histopathological examination revealed dual pathology for the same. A subserosal lipoma with presence of heterotopic gastric mucosa was diagnosed in the ileum as the leading pathological point of ileo-ileal intussusception. This case highlights the importance of pathological examination to know the specific cause of intestinal obstruction.


Figure 1. Pre-operative USG showing a polypoidal hypoechoic mass from the bladder diverticulum.
Figure 2. CT Scan showing a polypoidal enhancing mass arising from the bladder diverticulum.
Figure 3. Histopathology showing urothelial carcinoma infiltrating the lamina propria with no evidence of detrusor muscle in the specimen.
Radical Cystectomy for Intradiverticular Bladder Carcinoma: A Case Report

October 2021

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54 Reads

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5 Citations

JNMA; journal of the Nepal Medical Association

Herniation of bladder mucosa through the bladder wall muscle layer is known as bladder diverticulum. The incidence of bladder diverticulum is 1.7. About 0.8 to 10% of the urinary bladder diverticulum develops carcinoma. Transitional cell carcinoma is the most common. Painless hematuria is the most common clinical presentation. Different imaging modalities along with cystoscopy are the key to accurate diagnosis and staging. High grade multifocal urothelial carcinoma in the bladder diverticulum is better managed by radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Here we report a case of a 66-year old gentleman of high grade multifocal urothelial carcinoma in bladder diverticulum managed with radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Such cases have been addressed adequately in the literature, but we did not find such cases from our country.


Metastatic Adenocarcinoma of Prostate posing as upper tract ureteral mass

September 2021

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5 Reads

Nepalese Journal of Cancer

Prostate cancer metastasis to the ureter is extremely rare because only 45 such cases have been reported worldwide in the last century. It accounts for 30% of ureteral metastasis. Neuroendocrine differentiation is approximately 1% of the entire primary prostate adenocarcinoma pathology. Metastatic prostate cancer may pose as upper tract urothelial carcinoma. Prostate may look normal on clinic-radiological examination in prostate cancer. Majority of such cases are managed with nephroureterectomy. Herein, we report a case of 62-year gentleman, who presented with refractory left flank pain with repeated imaging suggestive of neoplastic left ureteric stricture and normal prostate on clinic-radiological examinations. The case was later found with the diagnosis of metastatic prostate adenocarcinoma with neuroendocrine differentiation after left sided nephroureterectomy done for a provisional diagnosis of Upper Tract Urothelial Carcinoma (UTUC).

Citations (1)


... One study found that 84% patients who underwent elective diverticulectomy for bladder diverticula exhibited mucosal inflammation, ulceration, dysplasia, squamous metaplasia, and leukoplakia [39]. Other investigators have suggested that chronic exposure to carcinogens and human papillomavirus (HPV) infection may contribute to neoplastic changes within a bladder diverticulum [40]. According to a review by Walker et al., urothelial carcinoma accounts for the majority of IDBT (72%), followed by small cell carcinoma (8.3%), urothelial carcinoma with squamous differentiation (5.6%), pure squamous cell carcinoma (5.6%), sarcoma (5.6%), and adenocarcinoma (2.8%) [16]. ...

Reference:

Urinary bladder diverticula: imaging features and complications
Radical Cystectomy for Intradiverticular Bladder Carcinoma: A Case Report

JNMA; journal of the Nepal Medical Association