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Journal of Histopathology and Cytopathology

 Information for Contributors

 General Information

The Journal of Histopathology and Cytopathology (JHC) aims in our understanding of the pathophysiological and pathogenetic mechanisms of human disease by publishing  original papers, review articles, case reports and short communications related to basic and translational fields in pathology. It serves as  bridges between basic biomedical science and clinical medicine with particular emphasis on, but is not restricted to, tissue based studies only. It is published twice a year as the Journal Committee of the Bangladesh Academy of Pathology.

Manuscript Preparation.

Manuscripts should be prepared in MS Word format in accordance with The Uniform Requirements for Manuscripts Submitted to Biomedical Journals

(see http://www.icmje.org). All pages of the manuscript should be double-spaced and numbered consecutively beginning with the Title page.  Each of the following sections should begin on separate pages: Title,  Name and affiliation of authors, Abstract and Keywords, Text, Acknowledgements, References, individual Tables and legends.  Reformatting of the accepted papers may be needed according to the Journal specifications.

Title Page

The title page should include (i) type of publication (original, review, case report etc.) (ii) the complete title of the article (iii) authors’ name in abbreviation  (iv) list of authors including full name, highest degree, signature, designation and institutional affiliation and (v) name, mailing address, email and telephone/mobile number of author responsible for correspondence.

Abstracts

It should begin with full title of the article. Do not write authors name in the abstract page. The abstracts should not be more than 200 words. The abstract should state the purpose of the study or investigations, basic procedures, main findings and principal conclusion. Three to ten keywords may be provided below the abstract using terms from the Medical Subject Headings (Index Medicus, NLM, USA). Abbreviations and citations should be avoided.

 Text

The text of the original articles should be divided into following sections: Introduction,

Methods, Result and Discussion.

 References

References to literature should be numbered in Arabic numerical in superscripts

consecutively in the order in which they are mentioned in the text. At the end of article the full list of references should give the name of all authors followed by the title of the article, the title of the journal abbreviated according to Index Medicus, the year of publication, volume number and first and last pages of the article. Title of the books should be followed by the edition, place of publication, the publisher, the year and the relevant pages. Examples of correct form of reference are given below: References should begin on a new page, be double-spaced and numbered in order of citation in the text, including citations in tables and figure legends. Citations that first appear in tables, figures, or supplemental data should be numbered according to the item’s first call out in the text; a separate reference list should not be prepared for supplemental data. Complete author citation is required (use of “et al” is only acceptable for sources with more than 35 authors).

References should conform to the style of the Journal.

 Examples follow:

Journals: van Riel D, Leijten LM, Kochs G, Osterhaus AD, Kuiken T: Decrease of Virus Receptors during Highly Pathogenic H5N1 Virus Infection in Humans and Other Mammals. Am J Pathol 2013, 183:1382-1389

 Electronic Journals: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group: Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009, 6:e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097

 Books: Frosch MP: Central Nervous System. Robbins Basic Pathology, 9th Edition. Edited by Kumar V, Abbas AK, Aster JC. Philadelphia, PA, Saunders, 2012, pp. 811-850

 Product Inserts: Cite in text only: (Affymetrix technical note: Globin Reduction Protocol: A Method for Processing Whole Blood RNA Samples for Improved Array Results. Santa Clara, CA).

 

Web sites: Cite in text only. See Data Supplements and Non-Traditional Media section below for proper use of web site references. Use the doi when available. Include the name of the institution sponsoring the web site, URL address with direct linkage to the referenced information, and date of last access.

Tables

Tables should be typed written on separate numbered pages submitted after the main text on separate pages, as part of the manuscript. The preferred file format for Tables is MS Word. and should follow the reference list. All tables should be numbered consecutively using Roman numerical. Each must carry a brief descriptive heading. Tables should be planned to fit within print area. Table footnotes should use the sequential symbols: *, †, ‡, §, ¶, ∥; and abbreviations.

Illustrations

Figure file formats (including those embedded in the text) are unacceptable.

Photographs and photomicrographs should be of high resolution (minimum 5 mega pixels), in original unedited form and jpg format. These should contain a legend with magnification and stain used. Figure number and name of the first author should be mentioned in each file. Legend should be given in separate page.  Patients’ identification should be hidden.

Abbreviation

Standard abbreviation should be used whenever possible. The full term for which

the abbreviation stands followed by abbreviation in parenthesis should be proceed

the first use of the abbreviation in the text except for standard units of measurements

like 27OC and 25 mmol/L etc.

Letters to the editor

Communications with reference to an article published in the journal and current health

problems in the community will be accepted as letter to the editor.

 Electronic Copy

An electronic copy (soft copy) in the form of CD must be submitted with the printed copy of the article. Electronic copy may be send by email attachment at sadequel@yahoo.com.

Text should be processed with MS Word and pictures should be saved in JPG format.

Manuscript Submission

Electronic version of the manuscripts should be submitted through email to the Executive Editor.  Alternatively send DVD/CD to: The Executive Editor of the Journal of Histopathology and Cytopathology.  A cover letter to the editor must accompany the manuscript stating any,  (a) conflicts of interest (both financial and personal), (b) that the manuscript has not been published previously and is not being considered concurrently by another publication, and (c) all authors and acknowledged contributors have read and approved the manuscript. Submissions are not considered for review if previously published in any form (print or online) other than as an abstract. The editor reserves the customary right to style and if necessary shorten the material accepted for publication and to determine the priority and time of publication. Editor assumes that work based on honest observations. It is not the task of the editor to investigate scientific fraud paper.

Proofs

The corresponding author will be contacted by email once proofs are ready, and will be directed to download electronic proofs from a secure website. The author should check the proofs carefully, mark any printer’s errors, and answer queries as requested. Author changes should be kept to a minimum. Proof corrections and replacement figures (if any) must be returned within 48 hours to avoid any delay in publication.

The Review Strategy

On receipt, manuscripts are assessed by the Editor-in-Chief, to one Associate Editor. The Reviewers’ and Associate Editor’s views are used by the Editor-in-Chief (or a Senior Editor) in reaching a decision, usually within three weeks of submission.

 Summary of Submission, General points

Format the word processing document as double spaced A4 pages with an additional space between paragraphs and margins of at least 2 cm all round. Use a 12-pt standard font such as Times, Helvetica or Arial (with Symbol for special characters). Do not use line numbering, but include page numbers in the header or footer, aligned right. Use consistent, preferably UK English spelling.

 Manuscript title

This should be clear, simple and concise; long titles lack impact. Please remember that many readers will only scan titles, so they should reflect the message of the paper and catch the readers’ attention.

 A short running title

This must be 75 characters or less, including spaces, and reflect the main title and content of the manuscript.

 List of authors

Authorship credit should be based only on 1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; 3) final approval of the version to be published.

 A statement outlining the specific contribution of each author to the manuscript and the work reported in it must appear after the acknowledgements section (see below).

 Full affiliations of all authors:

Include the name of the department(s) and institution(s) to which the work should be attributed. Append the corresponding author(s) full postal address, phone number and email address.

 Conflict of interest statements

Authors must disclose all financial and personal relationships that might bias their work; to prevent ambiguity, a conflict of interest statement must appear on the manuscript title page, detailing any conflicts (or the absence thereof) for each author.

 Word count (from beginning of Introduction to end of Discussion)

Concise articles make a greater impact than long ones and are less likely to be delayed by editing to a suitable length. Full articles should be no more than 4000 words from the beginning of the Introduction to the end of the Discussion. Review articles and special features may occasionally exceed this limit by arrangement with the Editor-in-Chief.

 Abstract (not structured and no more than 300 words)

Following the title page(s), the next page should carry an unstructured prose abstract of 300 words or less. It should clearly convey the purposes of the study, and the main procedures, findings and conclusions. It should be understandable without reference to the rest of the paper, and contain no citation to references in the reference list. Only standard abbreviations as listed below are permitted.

 Keywords (3 to 10)

Below the abstract, authors should provide and identify as such 3 to 10 keywords or short phrases to assist indexing the article and that may be published with the abstract. MESH headings are a useful guide for authors in considering keywords.

 Manuscript structure

Research articles are divided into sections with the headings: Abstract, Introduction, Methods, Results and Discussion. Long articles may need subheadings (especially within the Results and Discussion) to clarify their content. The sections should not be numbered. Other types of articles, such as reviews and commentaries, still need a title and abstract and should adhere as closely as possible to these guidelines.

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jhc-2019-jul-v-3-n-2-mesenteric-ms

Mesenteric Cystic Lymphangioma – Case Report

 

*Nazrin MS,1 Rahman DS2

 

  1. *Dr. Mosammet Suchana Nazrin, Professor & Head, Department of Pathology, North East Medical College, Sylhet, Bangladesh. nazrinsuchana@gmail.com
  2. Dil Shakira Rahman, Lecturer, Department of Pathology, North East Medical College, Sylhet, Bangladesh.

 

*For correspondence

 

Abstract

Cystic lymphangioma is a rare tumor of lymphatic origin. Incidence of intra-abdominal lymphangioma  accounts <5%. A 4 years old boy, admitted in the North East Medical College and Hospital, Sylhet, Bangladesh with the complaints of abdominal distension,  severe pain in whole abdomen, nausea, anorexia and vomiting. CT findings were suggestive of mesenteric cyst. At laparotomy, a cystic tumor was found in the mesentery, that  was attached to bowel loops. Histopathological examination confirmed the diagnosis of cystic lymphangioma.

 

[Journal of Histopathology and Cytopathology, 2019 Jul; 3 (2):172-174]

 

Key words: Lymphangioma, Cyst, Mesentery.

 

Introduction

Lymphangioma is a rare cystic tumors of lymphatic system, characterized by proliferating lymphatic vessels, occurs most commonly in the head, neck and axilla.1 Other sites include mouth, arm, mediastinum, lung, abdomen and viscera. Intra-abdominal cystic lymphangiomas are rare and comprises less than 5% of all cystic lymphangiomas.2 Differentiating cystic lymphangioma from other cystic growths by imaging techniques alone is often inconclusive and surgery followed by histopathological examination is required for final diagnosis. We are here reporting  a rare case of mesenteric cystic lymphangioma in a 4 years old male children.

 

Case report

A 4 years old boy, admitted in the North East Medical College and Hospital with the complaints of abdominal distension and severe pain in whole abdomen for 15 days, nausea and anorexia for 15 days and vomiting for 1 day. On physical examination, abdomen was hugely distended. Tenderness was present in whole abdomen. There was no organomegaly. Umbilicus was everted and transverse slit was present. The laboratory data presented no anaemia,  CRP was 10 mg/dl, serum creatinine 0.5 mg/dl, serum electrolytes showed Na+ 141 mmol/L, K+ 4.4 mmol/L, Cl– 105 mmol/L, HCO3–18 mmol/L. However, computed tomography revealed a large cystic mass of about 16x13x10.5 cm, which extended from right side of upper abdomen to pelvic cavity and displaced adjacent gut loops towards left. No soft tissue component or calcification was seen within the cyst. There was also right sided hydronephrosis, probably due to pressure effect of the cystic mass. Patient was diagnosed clinically as a case of mesenteric cyst.  Laparotomy was done under general anaesthaesia. On laparotomy, there was a mesenteric cyst in the abdomen. Aspiration was done. The fluid color was haemorrhagic, probably due to pressure effect and congestion of the blood vessels. The cyst was clinically designated as mesenteric cyst and sent for histopathological examination.

 

 

On gross examination, there was a cystic mass measuring 7x 6 x4 cm size. The surface was smooth. On cut section, it was multiseptate and multiloculated with various sized cystic spaces. Microscopic examination showed multiple cystic spaces separated by fibrocollageous stroma. The cysts were lined by single layer of endothelium. The lumens were filled with homogenous eosinophilic material with a few clusters of macrophages. The stroma was infiltrated with lymphocytes, forming lymphoid aggregates. Histopathological examination confirmed the diagnosis of mesenteric cystic lymphangioma. The post-operative period was uncomplicated and the patient was discharged on 6th postoperative day.

Discussion

Lymphangioma, a rare cystic tumors of lymphatic system. It is  a benign, slow-growing lesions, characterized by proliferating lymphatic vessels, preferentially located in the head & neck (75%), axilla (20%). Incidence of intra-abdominal lymphangioma (accounts <5%), have been reported in the mesentery, genitourinary tract, spleen, liver & pancreas.3 Abdominal cystic lymphangiomas arises from mesentery (59% – 68%), omentum (20-27%), and retroperitonium (12-14%).4 Abdominal cystic lymphangioma is  more frequent in boyes (5:2) with mean age at 2 years.5 Intra-abdominal cystic lymphangiomas is most commonly presented with abdominal mass and distension, loss of appetite, nausea and vomiting.1,2,6 Ultrasound findings are not specific, the computed tomographic scan allows the initial diagnosis.1 The diagnosis of cystic lymphangioma can only be confirmed by histological examination.

 

Conclusion

Cystic lymphangioma is a rare benign tumor that may be arises in various sites. Confirmatory diagnosis of this lesion includes laparotomy followed by histopathology.

 

Reference

  1. Chaker K, Sellami A, Ouanes Y, et al. Retroperitoneal cystic lymphangioma in an adult: A case report. Urol Case Rep. 2018;18:33-34.
  2. Karkera PJ, Sandlas GR, Ranjan RR et al. Intra-abdominal cystic lymphangioma in children: A case series. Arch IntSurg 2012;2:91-95.
  3. Bhavsar T, Saeed-Vafa D, Harbison S etal., Retroperitoneal cystic lymphangioma in an adult: A case report and review of literature. World Journal of Gastrointestinal Pathophysiology. 2010; 1(5):171-176.
  4. Muramori K, Zaizen Y and Nogushi S. Abdominal lymphangioma in children: report of three case. Surgery today. 2009; 39: 414-417.
  5. Kati O, Gunor S, Kandur Y. Mesenteric cystic lymphangioma: Case report. Journal of Paediatric Surgery 2018;35:26-28
  6. Rami A, Mahmoudi A, EiMadi A, et al., Giant cystic lymphangioma of mesentery: varied clinical presentation of 3 cases. Pan Afr Med J. 2012; 12:7
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jhc-2019-jul-v-3-n-2-multilocular-islam-f

Case Report

Multilocular Cystic Nephroma in an Adult Patient: A Case Report

*Islam F,1 Begum A,2 Kamal M3

 

  1. *Dr. Farhana Islam, Assistant Professor, Department of Pathology, Popular Medical College, Dhaka. ifarhana2006@gmail.com
  2. Afroza Begum, Associate Professor, Department of Pathology, Anwer Khan Modern Medical College, Dhaka.
  3. Mohammed Kamal, Professor of Pathology, BSMMU, Dhaka.

 

*For correspondence

 Abstract

Multilocularcystic nephroma is relative rare, cystic neoplasm of the kidney and is usually benign. There are two peaks in the incidence of the tumor, with a bimodal distribution presenting in the first 2 to 4 years of life, and again in 40 to 60 years.They are usually incidentally found as an asymptomatic abdominal mass. Radiologically, it is difficult to differentiate between cystic nephroma and cystic RCC in adults. The exact diagnosis primarily depends on the histopathologic examination. We present a 35-year-old male patient with a palpable mass over the right upper quadrant of the abdomen, which was gradually increasing in size. A Right sided  nephrectomywas performed on thispatient. Microscopically, the tumor composed of variable-sized cysts lined by a layer of flattened or cuboidal cells thatconfirmed a diagnosis of Multilocular cystic nephroma.

[Journal of Histopathology and Cytopathology, 2019 Jul; 3 (2):167-171]

 Key words: Multilocular cystic nephroma, Kidney, Benign renal tumor

Introduction

Multilocular cystic nephroma (MLCN) is a rare, benign cystic neoplasm of the kidney. It was first described in 1892 as cystic adenoma of the kidney and over 200 cases have been reported in the literature so far.1 MLCN is an uncommon, benign cystic lesion of the kidney with bimodal age distribution, occurring in both infants and adult population. Although it has been described in neonates, MLCN is more commonly seen in the age group of 2–4 years (of which 73% are in males). Below 4 years of age, male to female ratio is 3:1 and boys are affected more than girls. In adults, it is seen in the 4th–6th decade with its male to female ratio being 1:8.2 The main complaint in children is abdominal mass, while in symptomatic adults predominant complaints are abdominal distension, and pain, recurrent urinary system infection, and hematuria.3 However, most of the patients with cystic nephroma are asymptomatic and usually found incidentally. Herein, we present a case of a 35-year-old male whodeveloped a multilocular cystic nephroma in the upperpole of the right kidney. The clinicalpresentation, radiological findings, and histopathologic results werereported and the literature was reviewed.

Case Report

Our case a 35 years old male was suffering from lower back pain for 4 years. He did not pay attention to it until he discovered a palpable mass over the right upper quadrant of the abdomen, which was gradually increasing in size. Routine laboratory examinations were all within normal limits. Abdominal ultrasonography showed right renal cystic mass including a cluster of variable-sized cysts separated by hyperechoic tissue at the upper pole of the right kidney (Fig-1). I.V.U was done and the report suggested of mass in right kidney possibly cyst. Both the kidneys were normal functioning (Fig-2) MRI report suggested a right cystic renal mass (stage-II, Fig-3). Right sided  nephrectomy was done. Specimen of kidney with part of right ureter and peri-nephric fat was sent for histopathological examination on March 2010.

 Nephrectomy specimen with part of perinephric fat measured (14x9x6) cm. Cut surface showed multilocular cystic growth measured 9 cm in maximum  diameter involving  whole upper pole and mid portion of the kidney. The largest locule of the cyst measured 3 cm in maximum diameter. The wall of these cysts were thin and the locules contained straw colored watery fluid. Adjacent parenchyma was normal(Fig-4).

Microscopically, the tumor was composed of variable-sized cysts separated by fibrous septa. The cyst wall was partly lined by flattened epithelium and partly by cuboidal epithelium. The stromal septae was made of dense fibrous connective tissue with scattered smooth muscles. No nephron elements were found in the stromal septa. No communication among locules was noted. Kidney tissue surrounding the growth showed no significant change (Fig-5,6,7). A multilocular cystic nephromawas diagnosed on the basis of this  histopathological findings.

No postoperative complication was encountered and the patient was discharged uneventfully 7 days after the surgical procedure. No recurrence was found during 3 years of follow-up.

Discussion

MLCN has at least 20–25 synonyms, which include multilocular cystic renal tumor, benign multilocular cystic nephroma, polycystic nephroblastoma, and so on. Its etiology and histogenesis is debatable, and in the past they were considered to be developmental lesions with malignant potential. According to the World Health Organization (WHO) classification of renal neoplasms, MCN is grouped with the mixed epithelial and stromal tumors (MEST). The term renal epithelial and stromal tumor (REST) can be used to encompass both MCN and MEST.2

Cystic nephroma has a special bimodal age distribution, one in childhood of 2 to 4 years of life, predominantly in boys, and the other in the 40 to 60 years of life. The disease is predominantly found in adult female with an 8-time prevalence compared to male. Similar to other renal tumors, classical signs can include palpable abdominal mass, abdominal pain, and gross hematuria. However, most of cystic nephroma were found incidentally and asymptomatically.4

Usual ultrasonographic findings are multiple hypoechoic spaces separated by thin septa. CT scan, on the other hand, usuallyreveals a multilocular cystic tumor with curvilinear calcifications. Herniation into the renal collecting system with septal enhancement is commonly seen.3 Although in our case the patient done Magnetic Resonance Imaging (MRI) but it is rarely indicated. Imaging features include usually hypointense signal on T1-weighted sequences (although this may vary) and hyperintense signal on T2-weighted sequences. Septa are usually hypointense on all sequences due to fibrous content.2

Unfortunately, it is pretty difficult to differentiate between cystic nephroma, cystic RCC in adults and Wilms tumor in children radiologically even on CT scan.5 Since definitive discrimination is not possible via radiologi­cal means, histopathological diagnosis is required for dif­ferential diagnosis.

Grossly, cystic nephroma is a well-circumscribed tumor with a smooth surface. The cut surface reveals variable-sized cysts separated by thin septa. The cysts contain mostly clear to yellowish fluid but occasionally dark-colored fluid because of blood clots retention. They may be herniated into the renal collecting system but do not communicate with renal pelvis. That is why only parts of patients have hematuria microscopically or macroscopically. Bilateral cystic nephroma and recurrence after excision was rarely reported. Only several case reports in childhood co-existing with nephroblastoma.6

The criteria for pathologic diagnosis were established by Powell et al. in 19517 and later modified by Boggs and Kimmelstiel in 1959,8 and include the following (1) The lesion must be multilocular (2) The cysts must, for the most part, be lined by epithelium (3) The cysts must not communicate with the pelvis (4) The residual renal tissue should be essentially normal, except for pressure atrophy (5) No fully developed nephrons are present within the septa. Our patient fulfills all 5 criteria.

Development of cystic renal cell carcinoma originating from CN has been also reported, and postoper­ative follow-up is recommended. Local recurrence or me­tastasis is limited to a few cases, and it has been reported that local recurrence especially in patients who underwent partial nephrectomy is a possibility which might be re­lated with incomplete resection.3 Contrarily, Castillo et al.9 presented a series of 29 cases, and couldn’t encounter any postoperative local recurrence or metastasis. Also in our case we didn’t observe any local recurrence or metas­tasis,after 3years of  postoper­ative follow-up.

Traditionally, treatment for any solid renal mass or multilocular cystic lesion was nephrectomy. Nowadays, partial nephrectomy has become the initial standard option for small renal mass.10 If the lesion is localized enough, excision of the lesion or partial nephrectomy can be considered, even for large tumor in children.11

Conclusion

Cystic nephroma is a rare, benign renal tumor, which progresses with a silent course, and demonstrates a bimodal age distribution, and it is difficult to differentiate from cystic RCC. Neither clinical signs nor radiological findings can obtain a pre-operative diagnosis of MLCN. Surgical intervention and histopathologicexamination are necessary for the final diagnosis. Noninvasively radiological follow-up is recommended after complete resection.

 References

  1. Edmunds W. Cystic adenoma of the kidney. Trans PatholSocLond. 1892;43:89–90.
  2. Wilkinson C, Palit V,Bardapure M et al., Adult multilocular cystic nephroma: Report of six cases with clinical, radio-pathologic correlation and review of literature. Urol Ann. 2013; 5(1): 13–17.
  3. Cavıldak İD, Çakıcı MÇ, Karakoyunlu N, Ersoy H. Cystic nephroma: A case report in adult patients. Turk J Urol 2018; 44: 373-6.
  4. Chih-Yin Y, Yi-Chia L, Te-Fu T and Thomas ISH, Cystic nephroma: A case report in adult patients. Turk J Urol 2018; 44(4): 373-6.
  5. Kurian JJ, Ninan PJ. A rare case of bilateral cystic partially differentiated nephroblastoma recurring as bilateral cystic Wilmstumour. BMJ Case Rep,2015; 2:1.
  6. Joshi VV, Beckwith JB. Multilocular cyst of the kidney (cystic nephroma) and cystic, partially differentiated nephroblastoma.Terminology and criteria for diagnosis. Cancer,1989; 64: 466-479.
  7. Powell T, Shackman R, Johnson HD. Multilocular cysts of the kidney. Brit J Urol 1951;23:142-52.
  8. Boggs LK, Kimmelstiel P. Benign multilocular cystic nephroma: report of two cases of so-called multilocular cysts of the kidney. J Urol 1956;76:530-41.
  9. Castillo OA, Boyle ET Jr, Kramer SA. Multilocular cysts of kidney.A study of 29 patients and review of literature. Urology 1991;37:156-62.
  10. Dong B. Multilocular cystic nephroma treated with laparoscopic nephronsparing surgery: A case report. Can UrolAssoc J, 2014; 8: 545-547.
  11. Tanaka Y. Laparoscopic partial nephrectomy for the treatment of large cystic nephroma in children. J Laparoendosc Adv Surg Tech A, 2014; 24: 901-906.