Background: A rare angioproliferative condition of the larynx, Kaposhi sarcoma typically affects the skin. Immunosuppressive treatment following organ transplantation and human immunodeficiency virus infection are the causes. Every type of Kaposi sarcoma has human herpesvirus-8. Laryngeal kaposi sarcoma is uncommon in immunocompromised patients; since its initial identification in 1965, 18 cases have been documented globally. A CO2 laser-assisted laryngeal microsurgery is performed through the mouth cavity to remove tumor when kaposi sarcoma of the larynx obstructs the airway. Case report: A 77-year-old woman complained of hoarseness, dry mouth, odynophagia, and dysphagia three months prior when she arrived at the Mongolian-Japan Hospital. Two years ago, she acquired hard, sensitive lumps that were palpable on her right arm, left ankle, and right thigh. At that time, she was diagnosed with Kaposiform hemangiodermatitis and treated at the National Center for Dermatology. HIV test results were negative. Immunohistochemistry: CD31 +/-, CD34 /+/. Using flexible nasopharyngeal endoscopy to get the diagnosis: There was a mass that was about 1.5–2–5 cm in diameter, bluish in color, smooth and movable, and spongy and vascular on the larynx, on the nasopharynx, behind the palatine tonsills, and supraglottic. Surgery: Through the use of Kleinsasser laryngoscopy and a 0-degree endoscope, pathological tissues were extracted under general anesthesia using a laryngeal microsurgical instrument and a laparoscopic bipolar coagulator. The tissues were then sent for histological evaluation, which revealed Kaposi sarcoma, sarcoma grade 1. Results of treatment Pain decreased and quality of life increased following surgery. Upon nasopharyngeal endoscopy, the vocal cord mobility was normal and the surgical incision was clean. Conclusion: Kaposi sarcoma is an extremely uncommon illness. A lower quality of life and further issues can be avoided with an early diagnosis and suitable therapy. It also needs to be continuously monitored because it is a potentially repeatable disease.

Background: Azoospermia is the most severe form of male infertility, affecting approximately 1% of male population and 10–15% of infertile men. In azoospermia cases, sperm retrieval from the testis or epididymis through surgical procedures is used for assisted reproductive treatments. When no sperm is retrieved, recent approaches in medicine suggest using immunohistochemical methods to evaluate spermatogenesis in testicular tissue and plan further treatments. Aim: To evaluate spermatogenesis in testicular tissue of azoospermic patients using immunohistochemistry and compare the findings with the clinical outcomes of sperm retrieval procedures. Materials and Methods: This study included 71 azoospermic men who underwent micro-TESE procedures at the IVF center (RMC) between 2019 and 2023. The excised testicular tissues were fixed, processed histologically, and evaluated using Johnson’s score. The presence of spermatozoa in seminiferous tubules was detected by immunohistochemical and immunofluorescence staining, using markers such as TEX101 and LDHC. Results: Johnson’s score was categorized into three groups: poor, moderate, and good spermatogenesis. These were statistically compared with hormonal levels and surgical sperm retrieval outcomes. There were significant differences in Johnson’s scores and serum FSH and LH levels among the three groups (p < 0.005). TEX101 and LDHC proteins were strongly expressed in the good group, weakly in the moderate group, and absent in the poor group. The success rate of sperm retrieval was 100% (17/17) in the good group, 96.29% (26/27) in the moderate group, and only 29.62% (8/27) in the poor group. Conclusion Histological evaluation of spermatogenesis in azoospermic patients can help predict the outcome of surgical sperm retrieval, indicating its clinical value in treatment planning.

Background: Gastroesophageal reflux disease (GERD) composes up to 28% of the esophageal disorders, and diagnosis of GERD is associated with a 10-15% of risk of Barrett’s esophagus, change of normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia. It is reported that gastrointestinal (GI) disorders are the second out of five leading diseases in ambulatory diagnosed diseases and in 2022, esophageal adenocarcinoma is ranked in the fourth of the 10 most prevalent cancers among Mongolian population. When the Barrett’s esophagus changes shift to dysplasia, risk of esophageal adenocarcinoma development rises 30-125 folds and every year, 0.8% of population with dysplastic changes suffer from esophageal carcinoma. Although specific staining methods for histochemical analysis has been introduced into pathological laboratories detecting protein, fat, nucleic acid and enzymes that contained in cells, there isn’t study has been conducted to investigate the diagnostic specificity of Alcian blue and PAS staining method among population with Barrett’s esophagus. Aim: We aimed to make a differential diagnosis with basic and histochemical staining method in esophageal biopsies from Second Central Hospital of Mongolia (SCHM) and Mongolia-Japan hospital of MNUMS. Results: A total of 589 biopsies were collected from the SCHM and Mongolia-Japan Hospital of MNUMS and hematoxylin and eosin-stained results were Barret’s esophagus (43 biopsies or 7.3%), followed by Squamous cell carcinoma (46 or 7.8%), GERD (60 or 10.2%), hyperplastic polyp (92 or 15.6%), chronic erosive lesions (242 or 41%), polyp (94 or 15.9%), adenocarcinoma (12 or 2%), respectively. We have re-examined 43 cases with Barrett’s esophagus staining with Alcian blue and PAS and as a result, acidic mucin will be blue, neutral mucin will be purple, mixed mucin will be blue-purple and nucleus will be stained blue, respectively. Immunohistochemical re-staining of 43 biopsies with BE, Alcian blue were 87.8% and PAS were 97.4%. Conclusion Barrett›s esophagus, esophageal papilloma and hyperplastic polyps are comprising most of the esophageal precancerous disorders, and 9.8% of esophageal carcinoma was diagnosed. Histochemical re-staining of esophageal intestinal metaplastic changes is significantly beneficial to confirmation of the diagnosis.

Background: Globally, an estimated 13% of adolescents aged 10–19 are affected by mental disorders. As of 2020, the number of children under the age of 19 in Mongolia was reported to be 1,289,587, reflecting a 0.9% increase compared to 2015. A 2013 study on adolescents found that 60.5% were categorized as mentally healthy, 30.5% exhibited emotional and behavioral difficulties, and 9% were diagnosed with a mental disorder. A study conducted in Govi-Altai Province between 2018 and 2019 reported that 58.6% of adolescents were classified as healthy, 36.1% experienced psychological difficulties, and 5.2% were diagnosed with a mental disorder. Internationally, adolescent mental health has been widely assessed using the Strengths and Difficulties Questionnaire (SDQ), with an increasing number of studies employing artificial intelligence-based predictive models. However, in Mongolia, research utilizing artificial intelligence and machine learning for analyzing large-scale mental health data remains limited. This gap underscores the need for the present study. Aim: Machine learning models were compared to determine adolescent emotional and behavioral problems using the SDQ. Materials and Methods: Data was collected from teenagers, teachers, and parents in Govi-Altai Province, and the databases were created for each group. The teenager database was divided into 10 folds by cross-validation, and the models were developed using machine learning methods and evaluated using their performance measures. The results were mainly analyzed using the Bayes model. Results: The teenagers have emotional and behavioral problems due to emotional and peer interactions, but they are at risk of developing disorders due to hyperactivity and behavioral changes. Conclusion Comparing the model performance results with previous studies, Bayesian model accuracy decreased by 0.03, sensitivity decreased by 0.08, and specificity increased by 0.01. Also, the difference between the performance evaluation metrics of the C50 and Bayesian models is very small, between 0.01 and 0.02. This shows that the performance of the Bayesian method is good when the number of attributes in the database increases. Compared to the results of the knowledge generated by the research, the participants are more likely to develop emotional and behavioral disorders due to their peer relationship indicators, such as other children generally not liking them, getting on better with adults, and due to emotional symptoms such as being unhappy and depressed.

: Background: According to the statistics, Gastrointestinal disorders (GIDs) are the second of the leading five diseases among Mongolians, with an estimated 20% of GIDs by pathological diagnosis in 2022. Additionally, esophageal adenocarcinoma is ranked in the 4^th of the 10 most common cancer. Esophageal adenocarcinoma and its predispositions, and pathological changes are mostly located lower part of esophagus. Barret’s esophagus (BE) is consequences of goblet cell replaces the stratified squamous epithelium due to chronic gastroesophageal reflux disease. If BE transfers to the dysplasia, its probability of carcinogenesis is 30-125 times higher, and 0.8% of dysplastic patients with BE diagnosed with esophageal adenocarcinoma. Pathologists play a critical role in confirming the diagnosis of BE and BE-associated dysplasia. Goblet cells are almost always identifiable on routine hematoxylin and eosin-stained sections with Alcian blue (at pH 2.5). Purpose: To diagnose the esophageal biopsies via pathological immunohistochemical assay. Methods and materials: We investigated 130 biopsies in 2017-2019 years from NFCH, and 254 biopsies in SSCH. Result A total of 384 biopsies were collected from both national central hospitals and hematoxylin and eosin-stained results were Barret’s esophagus (50 biopsy or 13%), followed by dysplasia (66 or 17%), GERD (55 or 14%), squamous cell carcinoma (49 or 13%), chronic erosive lesions (41 or 11%), chronic esophagitis (40 or 10%), polyp (19 or 5%), adenocarcinoma (15 or 4%), acute esophageal erosion (5 or 1%), hyperplastic polyp (36 or 9%), and were others (8 or 2%), respectively.
As a result of immunohistochemical re staining of 50 biopsies with BE, Alcian blue were 87,8% and PAS were 97,4%.

Introduction: Hepatocellular carcinoma incidence and mortality per 100,000 population in Mongolia is the highest in the world. The individual’s genetic factors and new genetic changes are considered an important effect on the origin and development cancer. We aimed to investigate whether p53R72P polymorphisms were associated with the risk of hepatocellular carcinoma in Mongolian patients. Material and Method: p53R72P polymorphisms were evaluated in 80 controls and 38 HCC cases using a PCRrestriction fragment length polymorphism assay. Results: The mean age was 58.5±13.6 years in the case group and 63.2±8.1 years in the control group. Hepatocellular carcinoma is most common in 50-59 (n=14, 36.8%) and 60-69 (n=14, 36.8%) ages. Of the HCC group, 4 (10.8%) were diagnosed with tumor at stage II, 23 (62.2%) at stage III, and 11 (27%) at stage IV.
The results revealed that the heterozygous (Arg/Pro (PR)) genotype of p53R72P increased statistically significant the risk of hepatocellular carcinoma (OR=4.222, 95% CI 1.669-10.684) compared to the wildtype (R/R) genotype. (p=0.002). Moreover, the homozygous (Pro/Pro (P/P)) genotype of p53R72P increased the risk of carcinoma (OR=1.333, 95% CI 0.414-4.299) but not statistically significant. (p=0.63). Heterozygous (Arg/Pro (PR)) genotype of p53R72P in the tumor tissue was associated with a statistically significant (OR=3.3, 95% CI 1.274-8.57) increase in the risk of HCC (p=0.014). Pro/Pro (PP) genotype increased the risk of the carcinoma by 2.4 times (OR=2.44, 95% CI 0.865-6.908), but it was not significant. (p=0.092). Pro/Pro (PP) genotype of p53R72P in the tumor tissue compared to normal tissue of a case group increased the risk of cancer by 1.8 times (OR=1.833, 95% CI 0.472- 7.126), which was not statistically significant (p=0.382). Conclusion Taken together, Heterozygous (Arg/Pro (PR)) genotype of p53R72P increases the risk of hepatocellular carcinoma in Mongolians. Further studies with larger populations are needed to confirm these results.

Background: Lung cancer is the leading cause of cancer death in both men and women. In the past decade, histopathological classification of lung cancer has become increasingly important in selecting the appropriate treatment. Methods: All cases of lung cancer diagnosed pathologically in the last 2.5-year period were retrospectively identified at National Cancer Center and performed by descriptive case series design. Results: The average age of our participants was 62, of which 82.2% were men. A total of 214 cases of lung cancer were reported, including 142 (66.4%) squamous cell carcinoma (SCC), 34 (16%) adenocarcinoma (AC), 4 (1.7%) NSCLC, 29 (13.6%) small cell carcinoma (SmCC) and 5 (2.3%) cases of other/unspecified type. Based on only morphology, initially 32 (17.7%) cases of NSCLC were diagnosed, whereas after immunohistochemistry (TTF-1 or NAPA positive/p63 negative, and vice versa) staining, this category reduced to 2.2%. Conclusions Among both males and females, SCC which is highly related to smoking was the most common histologic type of lung cancer. Our results showed that an approach of using only a two-antibody panel (p63 and TTF-1) might help in the reduction of diagnostic category of NSCLC-NOS significantly.

Background: Infectious keratitis is a disease caused by inflammation, infection, and other ocular damage to the outer and other deep layers of corneal epithelium. It is a major cause of monocular blindness and visual disability worldwide regardless of age and gender. Therefore, we aimed to determine the clinical features and risk factors of infectious keratitis among Mongolians and to identify the causative microorganism and compared them with the treatment results. Methods: We collected the data of 149 patients who diagnosed as infectious keratitis at the Ophthalmology Department of the First State Central Hospital in 2017-2020 and using a case series model of descriptive study. Statistical analysis was calculated using Stata14 software. Results: The majority of patients in our study were male, with a male-to-female ratio is 2.1:1. The cause of infectious keratitis were categorized and eye injury-induced keratitis accounted for the highest percentage of 38.3% (n=57), with the majority being men 73.7% (n=42) (p=0.028). As for the type of treatment, antibacterial drugs 103 (69.1%) and evisceration 27(45%) predominate. Conclusion Our study shows that the majority of infectious keratitis in Mongolia is due to trauma in male patients. Forty-five percent of all surgeries involve evisceration surgery, which reduces the client's quality of life.

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.

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.