1. The comparative study of thyroid isotope scanning and FNA cytology in the nodular lesion of thyroid gland
Suren O ; Tuul B ; Puregmaa KH ; Sаyamaa L ; Ulzii-Orshikh N ; Enkhtuya B ; Bayarmaa E ; Ganzorig B
Innovation 2016;10(3):32-36
Thyroid nodular lesions are the common clinical problem in the world. A variety of tests have been employed to separate benign from malignant thyroid nodules. These tests include isotope scanning and fine needle aspiration cytology (FNAC). Our research was based on the fact that the comparison of FNAC and thyroid isotope scan in thyroid nodule was not researched in Mongolia. Therefore, we want to evaluate the specimen adequacy of FNAC, and compare its result to thyroid isotope scanning in patients with thyroid nodule. The research was conducted on archive materials of FNAC and thyroid isotope scanning of patients with thyroid nodule who were treated in surgical department of The First Central Hospital from 2012 to 2015, and the statistic analyze was done by using SPSS 20 under the auspices of School of Pharmacy and Bio-Medicine,Department of pathology, Mongolian National University of Medical Sciences. We have collected the FNAC of 807 patients, including 34 patients (4.2%) were males and 773 patients (95.8%) were females. FNA cytology results were interpreted as benign in 495 cases (61.3%), follicular lesion of undetermined significance in 31 cases (3.8%), follicular neoplasm in 9 cases (1.1%) suspicious in 17 cases (2.1%), malignant in 3 cases (0.4%), and unsatisfactory in 252 cases (31%). We have got the result of thyroid isotope scanning of 43 (5.32%) patients out of 807 cases. On thyroid scan, 18 patients (41.9%) having cold nodule were labeled as suspicious for malignancy, 25 patients (58.1%) had hot nodule. The FNA diagnosis of 25 patients with a hot nodule following: 1 patient (4%) with neoplasm, 17 patients (68%) with benign results, 6 patients (24%) had non-diagnostic. The FNA diagnosis of 18 patients (41.9%) with cold nodule following: 1 patient (5.5%) with follicular lesion of undetermined significance, 10 patient (55.5%) with benign, 5 patient (27.7%) with non-diagnostic, 2 patient (11.1%) had malignant. The FNAC results were interpreted as benign in 495 cases (61.3%), malignant in 3 cases (0.4%), and unsatisfactory in 252 cases (31%). Two patients out of 18 patients with cold nodule diagnosed as malignancy by FNAC. The sensitivity and specificity of thyroid isotope scanning was 96% and 16.6%, respectively.
2.Diagnosis of intraoperative squash cytology in brain tumors
Enkhee O ; Tsetsegdelger M ; Bolortuya B ; Enkhbat TS ; Khusyan KH ; Tuul B ; Bayarmaa E
Mongolian Medical Sciences 2014;170(4):14-18
Background: The intraoperative smear cytology (squash preparation) is fairly accurate, simple, reliabletool for rapid intraoperative diagnosis of neurosurgical biopsies [1]. In the early 1930s, Dr Eisenhardtand Cushing introduced intraoperative cytological investigations for rapid examination of neurosurgicalspecimens and guidance of surgical treatment [2]. Besides rapid decision making during neurosurgicalprocedures, it is also to be ensured that minimum injury is caused to the normal brain structuressurrounding the intracranial neoplasm. It has become necessary for pathologists to train themselves inthe interpretation of cytomorphological features of various central nervous system lesion and used inmany neurosurgical units of all over the world [3]. Thus, to begin doing intraoperative squash cytology inour practice is the aim of this study.Aim: To study the diagnostic accuracy of squash cytology in the intraoperative diagnosis of centralnervous system tumorsMaterials and Methods: The material for this study was obtained from 30 cases of nervous systemneoplasms sent for intraoperative consultation from State Third Central Hospital, Shashtin to the thirdsection of National Center for Pathology between 7th of November 2013 to 28th of March 2014. Squashpreparation was performed on all cases and stained with hematoxylin and eosin. The diagnosis given onsquash cytology was then compared with final diagnosis given on paraffin-embedded sections.Results: Of total 30 cases of primary central nervous system tumors, neuroepithelial tumors are thelargest category of tumors (50%). The accuracy of squash cytology was 82.1%.Conclusion: This is the first study in our country where intra-operative squash cytology in brain tumorwas done and diagnostic accuracy was 82.1% as very good category. There were 4 cases had diagnosticdiscrepancy.
3.Immunohistochemical study of cervical lymph node metastases of unknown primary origin
Enkhee O ; Tuul B ; Bold M ; Bulgan P ; Ulambayar E ; Odkhuu J ; Bayarmaa E
Mongolian Medical Sciences 2013;166(4):21-26
Introduction. Cancer of unknown primary (CUP) is histologically defined as the presence of a metastasis of lymph node without detection of the primary tumor [1]. Approximately 3–15% of all cancers are designated as CUP [3. 4]. The diagnosis, treatment and monitoring of patients with laterocervical metastases of unknown primary involves a wide range of oncologic entities [5]. While we were studying patho-histological examination of cervical lymphadenopathy in Mongolian, werevealed unknown primary tumor. This is a goal of our study. Objectives of study are followings to differentiate whether primary lymphoma or metastatic cancer of cervical lymph node metastasis of unknown primary tumor and to reveal primitive origin of tumor using by basic and additional immunohistochemical markers.Goal.To determine the conclusive diagnosis in cervical lymph node metastasis of unknown primary origin by immunohistochemical techniqueMaterials and Methods. In this study, we examined immunohistochemically 30 cases of outpatient head and neck surgical unit of the National Cancer Center and dentistry and oral maxillofacial surgical unit of the State Central Hospital which were diagnosed as cervical lymphadenopathy. For immunohistochemical study, we applied an immunohistochemical panel in accordance with avidinbiotin- peroxidase complex method and used a basic and additional antibodies represented by CK(pancytokeratin), LCA, synaptophysin, chromogranin and HMB45. Result. In our study, there was 63.3% lymphoma, 36.7% metastatic cancer. Among them, there were 4 of digestive tract adenocarcinoma, 3 of squamous cell carcinoma /2-esophagus, 1-nasopharyngeal/, 2 of neuroendocrine tumor and 1 of melanoma.Distribution by age groups shows that 20-29 years were 4(13.3%), 30-39 years were 10 (33.3%), 40-49 years were 8 (26.7%), 50-59 years were 3 (10%), over60 years were 5 (16.7%). Gender distribution showed an increased incidence of males (56.7%, 17 cases) compared with females (43.3%, 13 cases).Conclusion: In our study, B cell lymphoma and digestive tract adenocarcinoma were the most common. In further, it is necessary to introduce an immunohistochemical method in patho-histological practice.
4.ЭС СУДЛАЛЫН ШИНЖИЛГЭЭНИЙ ЧАНАРЫН ГАДААД ХЯНАЛТЫН АСУУДАЛД
Bolorchimeg Kh ; Tuul B ; Narantuya N ; Bolormaa O ; Tserenpil B ; Bayarmaa E ; Sayamaa L
Innovation 2017;11(2):26-28
BACKGROUND. Uterine cervical cancer is the fourth leading cause of cancer deaths
in women worldwide. In our country, cervical cancer is second most common cancer
in women. Uterine cervical smear (Papanicolaou test) remains an effective and widely
used method for early detection of precancerous and cancerous lesions. Since 2002,
the cervical smear was introduced to the clinical practice of our country. However,
there is no study to performed external quality assurance of cervical smear until now.
MATERIALS AND METHODS. We selected 20 glass slides of uterine cervical smear, the
diagnosis was approved by histopathology. Each chosen slides were evaluated by four
cytologists of A, B, C, D hospitals with hidden clinical information, independently.
RESULTS. The sensitivity of A, B, C and D hospitals were 87.5%, 93.3%, 93.3%, and 93.3%,
respectively. The specificity of A, B, C and D hospitals was 85.7%, 85.7%, 75%, and 66.6%,
respectively. The diagnostic concordance of A, B, C and D was 70%, 75%, 50%, and 55%,
respectively. The agreement of cytological diagnosis was moderate (kappa = 0.55),
moderate (kappa = 0.43), fair (kappa = 0.37), and fair (kappa = 0.33) in A, B, C, and D
hospitals, respectively. CONCLUSION: The external quality assurance in cytopathology
is needed in Mongolia. The diagnostic concordance method would be applicable in
our country to improve diagnostic agreement.
5.Expression of the WT1 protein and Ki67 proliferation index in brain glioma
Enkhee O ; Gheeyoung C ; Tuul B ; Bayarmaa E
Mongolian Medical Sciences 2019;187(1):17-22
Introduction:
Wilms’ tumor 1gene was originally discovered as mutated in nephroblastoma, a common pediatric kidney cancer also known as Wilms’ tumor. This gene’s product alteration was indicating the safety of WT1 immunotherapy as well as a potential therapeutic response to its application in patients with glioma.
Goal:
Our aim was to further elucidate the role of WT1 as a diagnostic and prognostic marker in brain glioma in
neuropathology field.
Materials and Methods:
In this study, formalin fixed paraffin embedded blocks of 135 patients with brain glioma were selected. After tissue preparation for WT1 immunohistochemical evaluation, 2 tissue preparations were excluded due to unsatisfactory amount of tissue. Therefore, data about tissue specimens from 133 patients were included in statistical analysis.
Results:
In this study, out of 133 cases, 55 were astrocytomas, 42 were oligodendroglioma, 35 were glioblastoma and 1 was mixed oligoastrocytoma.WT1 immunohistochemistry expression was found in 127/6 (95.5%) samples. For the glioblastoma, WT1-expression significantly increased with patient’s age (p=0.05, table 3). WT1 expression and Ki67 proliferation index had prognostic effect in patients with brain glioma (p<0.05), and low expression mean survival was 48.5 months, high expression survival was 18.4 months respectively.
Conclusion
WT1 expression in Mongolian patients with brain glioma had significantly associated with several adverse prognostic indicators including high Ki67 proliferation index (high grade tumor) and high expression of WT1 and univariable survival.
6.Spinal muscular atrophy: recent achievements in epidemiology, testing and gene therapy
Sarantsetseg T ; Erdenetuya D ; Yesukhei B ; Khandsuren B ; Oyungerel B ; Bolormaa D ; Mandakhnar M ; Tuul O ; Yundendash D ; Nyam-Erdene N ; Batchimeg B ; Munkhbayar S ; Chimedlkham B ; ;
Mongolian Medical Sciences 2023;205(4):75-83
Background:
Spinal Muscular Atrophy (SMA), an autosomal recessive disorder characterized by lower motor neuron
loss, leads to progressive muscle weakness and atrophy. With a neonatal incidence ranging from
1:6000 to 1:11000, individuals affected by SMA face challenges in locomotor function. The advent
of newborn screening tests, early diagnostic techniques, and the introduction of gene therapy have,
however, shown promise in enabling the acquisition of these motor skills.
Objective:
This review article seeks to shed a light on current understandings of the epidemiology, clinical
presentations, diagnostic methods, and treatments for spinal muscular atrophy, highlighting cutting
edge approaches within the discipline.
Methods:
A thorough search was conducted on PubMed, Cochrane, National Institutes of Health, and Web
of Science databases for recent research articles concerning SMA’s incidence, prevalence, clinical
manifestations, early detection, genetic testing and contemporary gene therapy.
Results:
The prevalence of SMA stands at 1-2 cases per 100,000 population, with an incidence of approximately
8 cases per 100,000 live births. Pre-1995 studies exhibited varying prevalence rates due to using non
molecular-biological methods, small localized populations, diagnostic errors, and regional characteristics.
Diagnosis involving Multiplex ligation-dependent probe amplification (MLPA), quantitative polymerase
chain reaction (qPCR), or next-generation sequencing (NGS) analysis to confirm SMN1 and SMN2
gene status aids in identifying carriers and SMA subtypes. Countries implementing newborn screening
programs have demonstrated early SMA detection in asymptomatic newborns, contributing to reduced
mortality and disability rates. Currently, several types of gene therapy are being used in the treatment
of SMA.
Conclusion
The epidemiology of SMA varies between countries and regions. It is fully possible to confirm the
disease, identify carriers and subtypes. The inclusion of SMA in newborn early detection programs is
crucial for reducing infant mortality and disability, and several gene therapies have received approval from relevant authorities for SMA treatment. In Mongolia, it is possible to introduce tests to confirm the
disease and determine carriers and subtypes.