Introduction : The HER2 (Human epidermal receptor 2) proto-oncogene encodes a transmembrane receptor protein involved in the development and progression of the majority of cancers. Prior studies have shown that HER2 oncogene is overexpressed in approximately 15–30% of ovarian carcinomas. However findings regarding the overexpression and prognosis are still conflicting. Goal: To determine the histomorphological structure of ovarian tumor and perform immunohistochemical analysis of HER2 in tumor tissues Materials and Methods: A total of epithelial ovarian cancer paraffin-embedded tissue blocks 11collected. The hematoxylin and eosin stained histopathology slides of each of the cases were reviewed to confirm the original diagnosis, and to assess the histological grade of the neoplasm. Our study was performed on 11 ovarian epithelial cancer tissues obtained at the time of first surgery. The staining procedure for HER2 overexpression was performed using a monoclonal antibody. Results: The positive expression rate of HER2 in this study was 81.8%. Significant association was not found between HER2 expression International Federation of Gynecologists and Obstetrics (FIGO) stage p-values of 0.196, grading 0.642 and histological subtypes. However, there were more cases of advanced-stage disease (III/IV) with HER-2 expression than early-stage EOC (I/II). HER2 positive tumor were grades 1, 2 and 3 respectively. A higher proportion of serous ovarian neoplasm and adenocarcinoma NOS was also observed to be HER2 positive. Conclusion HER2 expression was observed to increase with advanced stages of cancer and was more commonly seen in serous rather than in adenocarcinoma NOS.

Introduction: Bile reflux gastritis is due to an excessive reflux of duodenal contents into the stomach. The increasedenterogastric reflux may provide the basis for increased mucosal injury. In clinical practice the symptoms of bile reflux gastritis are nonspecific than the other gastritis. Only endoscopy and biopsy can confirm the diagnosis. Observation demonstrates that, in practice there is tendency to increase the bile reflux gastritis. However, in Mongolia there are much less research and studies in this area. Goal: Evaluate the endoscopical and histological changes caused by duodenal reflux on the gastricmucosa Materials and Methods: We included in our study 70 patients with bile reflux gastritis admitted in Second General Hospital in Ulaanbaatar. In all cases we performed an upper gastrointestinal endoscopy and at least 4 biopsyspecimens were done from antral mucosa and the histological features were scored in accordance with the Sydney system. Results: The average age of the patients with bile reflux gastritis was 61.64±9, 69 years. Reflux gastritis was noted to 15 males and 55 females. Gastroduodenal reflux after chlocystoectomic surgery was noted in 46 cases (65.71%), and biliarytract disease was noted in 16 cases (22.85%). The average time interval from original operation tothe discovery of the bile reflux gastritis was 9.22 years after chlocystoectomic surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa in 41 cases (58.57%),gastric antral atrophy in 20 cases (28.57%), gastric diffuse atrophy in 27 cases (38.57%), thepresence of bile into the stomach in 70 cases (100%), erosions in 3 cases (4.28%), gastric ulcer in2 cases (2.85%), intestinal metaplasia in 10 cases (14.28%).The histologic alterations observed from tissues collected during endoscopic examination were chronic super facial gastritis in 19 cases (27.14%), chronic atrophic gastritis in 51 cases (72.85%),an intestinal metaplasia in 32 cases (14.28%), gastric erosions and ulcer in 4 cases (5.71%),dysplasia in 1case (1.42%), Helicobacter pylori infection in 14 cases (20%). Conclusions The most frequent risk factors for bile reflux gastritis were chlocystoectomic surgery and biliary tract disease. Histological findings of patients with bile reflux gastritis revealed gastric cancer precursor lesions, therefore follow-up endoscopic examinations and early treatment of bile reflux are essential.

Kidney transplantation is the best alternative treatment for end-stage renal disease and health-related quality of life and survival of the patients are improved compared with dialysis. Worldwide, more than 1.4 million patients with CKD receive renal replacement therapy with incidence growing by approximately 8% annually.1 Unfortunately, despite significant improvement in graft function, kidney transplants can still fail due to acute rejection and chronic allograft nephropathy.2 Kidney biopsy after transplantation, which has evaluated by Banff 09 classification is usefull method for diagnose of transplanted kidney disease.3,4Kidney graft rejection was diagnosed in 10 renal allograft biopsy specimens (bs) obtained from transplant patients followed up at our institute between 2015 and 2016. All specimens were evaluated as satisfactory which show more than 8 glomerulus under the light microscopy. Each renal cortical tissue was divided into two tips: one piece for routine H&E stain and special stains, including Masson’s trichrome, and PAS stain; another piece for immunofluorescence by frozen section, which were stained with IgA, IgM, IgG and complement component (C3, C4, C1q, C4d). All the renal biopsies were examined by the same pathologist.Out of 117 transplantations, 10 episodes of rejection selected. Among the 10 patients, 30% had an acute T cell rejection and 70% had a chronic allograft nephropathy. Interstitial inflammation (i1-7) was present in 7 bs (70%), tubulitis (t1-4,t2-2) in 6 bs (60%), transplant glomerulitis (g1-1, g2-2, g3-1) in 4 bs (40%), transplant interstitial fibrosis (ci1-2, ci2-2, ci3-2) in 6 bs (60%), tubular atrophy (ct1-6, ct2-2, ct3-1) in 9 bs (90%), mesangial matrix increase (mm1-5) in 5 bs (50%), vascular fibrosis intimal thickeness (cv1-3) in 3 bs (30%), arteriolar hyaline thickening (ah1-5) in 5 bs (50%), tubulitis (ti1-6, ti2-3, ti3-1) in 10 bs (100%) and peritubular capillaritis (ptc1-1, ptc2-2, ptc3-1) in 4 bs (40%). C4d deposition was present very mild in wall of the vessels and peritubular capillaries. Because of not good working Methenamin silver stain, we couldn’t demostrate glomerular basement membrane changes (cg) fully.We suggest that histopathological changes of transplant glomerulopathy might be accompanied by inflammation of the microvasculature, such as transplant glomerulitis and peritubular capillaritis. C4d deposition in the wall of the vessels and peritubular capillaritis is not always present in biopsy specimens of transplant glomerulopathy.

Background Systemic Lupus Erythematous (SLE) is a multi-systemic autoimmune disease with numerous patterns of clinical and immunological manifestations. Renal disease in SLE occurs in 40–75% of patients, most often within five years of disease onset, and is one of the strongest predictors of a poor outcome. Anti-dsDNA antibodies are reported to be more prevalent in patients with SLE who have renal disease. Anti-Sm, anti SSA and anti SSB antibodies are also considered to play a pathogenic role in inducing renal symptoms in SLE, and a strong correlation has been seen in lupus nephritis (LN) between disease activity and anti-dsDNA antibody levels. Objective The aim of our study is to highlight the clinical and laboratory features in SLE patients. Methods This is a three year hospital based case-control study of patients with renal diseases, who were admitted to the nephrology and rheumatology units of the 1st central Hospital and 3rd central hospital, Mongolia. Standard methods were used for laboratory testing. Autoantibodies (C/P-ANCA, anti-dsDNA, anti-Sm, anti-SS-A/Ro, anti-SS-B/La, anti-Scl-70, anti-GBM) measured by Enzyme Immuno Assay (Germany, ORGENTEC Diagnostika GmbH). Renal function was evaluated by the eGFR (estimated glomerular filtration rate) using the Cockcroft-Gault formula. Result The study included 27 patients with lupus nephritis and 78 controls with other types of GN. There were 85.2% of female patients in the lupus nephritis group. Patients with LN were significantly younger than the controls (mean (SD) 31.9 (10.1) years vs. 37.1 (11.9) years; p=0.036). For the serology, a higher proportion of anti dsDNA (46.1%), anti Sm (29.6%), anti SSA (63%) and anti SSB (11.1%) were seen in the group with lupus nephritis (p=0.001; p=0.043; p<0.0001; p=0.096, respectively). The Pearson’s correlation analysis indicated that the level of anti-dsDNA (r=-0.249, p=0.021) and anti SSA (r=-0.195, p=0.048) were significantly correlated with the renal function (eGFR). All had dipstick proteinuria 1+/2+/3+, more than 10 red blood cells/hpf hematuria (n-12, 44.4%) in lupus nephritis group and renal function (mean eGFR (SD) 88.1 (51.3) ml/min vs. 112.3 (67) ml/min; p=0.05) was more decreased in lupus nephritis patients than controls. Conclusion Notably, rising titers of antibodies to dsDNA, SSA may indicate exacerbations of glomerulonephritis.

BackgroundIgA nephropathy and MPGN are common glomerulonephritis in the world that progresses slowly andrenal function can even remain unchanged for decades. Clinically, it presents by isolated hematuria,proteinuria. Histologically, IgA nephropathy presents with acute glomerular damage, mesangial cellproliferation, endocapillary leucocyte infiltration, and crescent formations, these lesions can undergoresolution with sclerotic healing. Since 2013, renal biopsy has been done at the First Central Hospitalof Mongolia a few times. However, the confirmative diagnosis of IgA nephropathy and MPGN remainunknown in Mongolia by renal biopsy. Therefore, we intended to test renal biopsy techniques andconfirm its diagnosis by renal biopsy at the Second Central Hospital of Mongolia.MethodsUltrasound guided renal biopsy had been done for four patients by nephrologist at the Departmentof Nephrology of the Second Central Hospital of Mongolia. All four specimens were evaluated assatisfactory which show more than 8 glomerulus under the light microscopy. Each renal cortical tissuewas divided into two tips: one piece for routine H&E stain and special stains, including Masson’strichrome, and PAS stain; another piece for immunofluorescence by frozen section, which werestained with IgG, IgM, IgA and complement component 3 (C3). Each case was screened by threepathologists.Results:The case which shows mesengial widening, mesengial hypercellularity under the light microscopyor mesangial granular deposition of IgA and C3 by immunofluorescence was diagnosed as IgAnephropathy. We obtained crescent formation with glomerular adhesion in most cases. In addition, weobserved secondary MPGN in one case, which is caused by hepatitis C virus infection.Conclusion: Probably, it is a new step for developing pathologic diagnosis for nephrology in Mongolia.We needs further study for improving renal biopsy technique and confirming the diagnosis of IgAnephropathy and MPGN using electron microscopy and pathological report by oxford classification forIgA nephropathy.

BACKGROUNDProstate cancer is the most frequent malignancy among men nowadays.METHODSImmunohistochemical expression of prostate-specific antigen (PSA) was retrospectively investigated in 10 patients admitted with clinical suspicion of the prostate cancer. Slides were collected from archived biopsiesandthey were stained for PSA.The final reaction product was evaluated as negative (0), weak/moderate positive (1), and intense positive (2).RESULTSGlandular prostate carcinoma was found in 40% (n=4) and undifferentiated carcinoma in 60% (n=6). The immunoreaction for PSA was intense positive in 30% (n=3), weak/moderate positive in 50% (n=5) and negative in 20% (n=2) of total cases.CONCLUSIONSWe concludethat PSA immunoreaction is helpful for the differential diagnosis based on our results.

Aim was to investigate expression of tumor suppressor P53 gene, proliferating Ki-67 protein inordinary and proliferating uterine leiomyomato establish possible usefulness of these two parametersin distinguishing between ordinary leiomyoma and proliferating leiomyoma. Retrospective study of49uterine leiomyoma (25 ordinary leiomyoma, 24 proliferating leiomyoma) technically acceptable foranalysis from years 2010–2013 department of Obstetrics and Gynecology and department of Pathology,Mongolian National University of Medical Science, Ulaanbaatar, Mongolia.MethodAll tissue specimens were obtained from surgically removed tumors. Tissue was fixed in formalinand cut to thickness of 5 mm from paraffin-embedded blocks. All haematoxylineosin slides and allimunohistochemical slides for each case were reviewed by two experienced pathologist.ImmunohistochemistryParaffin-embedded tumor sections were deparaffinized and stained in automated platformDakoCytomationusing monoclonal mouse anti-human Ki-67 antigen (Dako,Glostrup, Denmark), monoclonal mouse anti-humanP53 protein (Dako, Glostrup, Denmark).Immunohistochemicalanalysis of P53 and Ki67 expression was performed. Every nuclei stained brown,regardless of shade intensivity, was considered positive. The interpretation of immunohistochemicalstaining was expressed as number of positive cells in 100 cell count in most active area of the slide.Non-parametric analysis of variance Kruskal-Walistest was performed.P53 expressionExpression of P53 was negative in 24/24 ordinary uterine leiomyoma, 2/10 mitotic activity leiomyoma,11/15 cellular leiomyoma. Expression of P53 in 1–10% of cells showed 3/10(30%) mitotic activeleiomyoma and 1/15(6.6%) cellular leiomyoma. Expression in 10-70% of cells showed 5/10(50) mitoticactivity leiomyoma, 3/15(20%) cellular leiomyoma. A significant difference in expression of P53 wasseen between ordinary and proliferative (mitotic activity and cellular) uterine leiomyoma (p<0.007, Table1).Ki-67 expressionExpression of Ki67 was negative in 20/20 (100%) ordinary leiomyoma, 4/11(36.3%) mitotic activityleiomyoma and 7/18(38.8%) cellular uterine leiomyoma. 1–10% of cells were positive in 4/11 (36.6%)mitotic activity leiomyoma, and 5/18% cellular leiomyoma. Expression was positive in 10-70%of cellsof 3/11(27.2%) mitotic activity leiomyoma and 6/18(33.3%). Statistically significant differences in Ki67expression was found between ordinary leiomyoma and proliferating leiomyoma (p<0.014, Table 2) andbetween LM and LMS (p=0.000, Table 1).Conclusion:The findings of our study in concordance with other study results are helpful information establishingmore diagnostic criteria and parameters for diagnosis in doubtful cases between two entities.Immunoassaying for Ki-67 and P53 are such parameters. The panel of their expression in specific caseeases diagnosis.

IntroductionMongolian rural population lack of access to adequate health services due to the fact that they live remotefrom urban hospitals. With the rapid spread of telemedicine in most countries, has been promoted as apromising tool to address deficiencies in delivering health care in developing countries.In late 2008 the Swiss Surgical Team (SST) started the telemedicine project MonTelNet in Mongolia incollaboration and with financial support of the Swiss Agency for Development and Cooperation (SDC).GoalThis study aims at evaluating the diagnostic accuracy of such a service by reviewing 212 telepathologydiagnoses delivered to the local experts in Ulaanbaatar between January 2009 and June 2013.Materials and MethodsUnder the MonTelNet project all province (Aimag) hospitals were equipped with hardware necessaryfor practicing telemedicine, in particular with computers with digitalized microscopes and cameras. Thesoftware CampusMedicus® (CM) was developed together with Klughammer GmbH. Software and alldata and comments exchanged over the MonTelNet are stored on a central server. Each of the originaldiagnoses issued through the CM telepathology (TP) server was compared to an independent reviewdiagnosis based on the original glass slides.RESULT For 188 specimens (89.9%) the TP diagnosis were completely identical with the review diagnosison the original glass slide. 12 specimens (5.7%) showed minor discrepancies (clinically identical) and 5specimens (2.4%) showed moderate discrepancies which were not clinically relevant. four cases (1.9%)exhibited a marked discrepancy (clinically relevant) between the TP diagnosis and the review diagnosis.Three specimens were classified as “other”.DISCUSSION The results of the study show a very high accuracy of the TP diagnosis provided. The TPdiagnoses differed markedly from the review diagnoses based on the original glass slide in only 1.9%of the 212 cases. 89.9% of all cases showed complete concordance between TP and review. Thesefigures are comparable to figures from other evaluations of static image telepathology.Conclusion:1. The results of the study show a very high accuracy (94.7%) of the TP diagnosis provided. TheTP diagnoses 89.9% of all cases showed complete concordance between TP and conventionalreview.2. Problem with image selection show a different picture and occur more often in cases with markeddiscrepancies between TP and review - χ2-test shows significant correlation (p<0.001).

Background: In recent years, kidney complication of diabetes became the basic cause of the end stage of renal disease in many countries around the world and then primary kidney disease goes on the 2-3 places. Due to the fact that diabetes mellitus turns more and more into non-communicable worldwide epidemic, we faced the increase in kidney complication which is one of form of micro vascular complications. So, illness of every 1-2 in three patients to undergo a renal replacement therapy has been diagnosed as diabetic nephropathy and of course nephrologists could not leave this fact without their attention. Goal: To study a change in the kidney structure with type 2 diabetic patients. Materials and Methods: Within the scope of the research 35 autopsied passed way because of the type 2 diabetes in clinical hospitals. According to Tervaert classification of diabetic kidney pathology issued by American Society of Nephrology in 2006, changes in glomerular structure were divided into 4 classes. Ordinary staining methods as hemotoxilin eosin, Van Gizonestaning connective tissue, Periodic Acid- Schiff standing have been used.Results: 35 autopsied in total, including 23 male (65.7%) and 12 female (34.3%) were covered by this research. And glomerular basement membrane thickening discovered in 51.4%, mesangial matrix expansion in 34.2%, Kimmelstiel-Wilson nodule in 20% and advanced glomerulosclerosis in 8.5% of total cases, respectively.Conclusions:1. It is found that diabetic kidney can be classified by Tervaert classification using ordinary standing and PAS reaction on the light microscope.2. However, we faced an essential necessity to be armed with immunofluorescence and electron microscope for the purpose to improve diagnostic examination and establish classes more accurately.3. Today when the medical science develops as evidence-based medicine, a starting the kidney biopsy samples assaying become the vital issue in comparative studying the clinical stage of diabetic kidney pathology.

BACKGROUND: Urinary bladder cancer (UBC) ranks ninth in worldwide cancer incidence. It is the seventh most commonmalignancy in men and seventeenth in women. UBC tends to occur most commonly in individuals over 65 orolder men and the male to female ratio are 3:1. The vast majority (over 90%) of bladder cancers are transitionalcell or urothelial carcinoma. Many experts did favor the 1998 World Health Organization/international Societyof Urological Pathology (WHO/ISUP) formulation for urothelial neoplasm. The 2004 WHO had accepted thenomenclature used in 1998, the system is currently used in countries of the world. Histology is the gold standardof typing, grading and staging to determine prognosis of the disease and process tactics of treatment. This newclassification system is not been introduced in our country yet, so UBCs are still formulated with the WHO 1973system. And there are no noted studies for UBC yet in Mongolia, these reasons were the background to determinethe UBC pathology with international classification system and nature of UBC in Mongolians.OBJECTIVE: To classify urinary bladder cancer occurred in Mongolia with the current histological classification and determinesspecific characters of pathology.MATERIALS AND METHODS: In this study we evaluated 138 patients with UBC diagnosed in Urological department of Central UniversityHospital, biopsy materials of these patients are classified with WHO/ISUP(2004) and results were analyzed.RESULT: Of the 108 patients with urinary bladder tumor, 2 patients (2%) were diagnosed with papilloma, 13 patients (12%)with papillary urothelial neoplasm of low malignant potential, 93 patients (86%) diagnosed with UC. Of 93 patientswith bladder carcinoma, majority of patients (91/98%) were diagnosed with urothelial carcinoma, 2 patients (2%)were diagnosed with adenocarcinoma. 74 (79.5%) of study patients were male, 19 (20.5%) were female and themale to female ratio was 3.9:1. Older man (over 50) was 65 (88%). Of UC (91), 1(1%) was carcinoma in situ,38 (42%) low grade papillary carcinoma, 33 (36%) high grade papillary carcinoma, 19 (21%) were no papillaryurothelial carcinoma. Of bladder carcinoma (93), 29 (31%) were superficial cancer (pTa, pTis), 58 (62%) wereinvasive cancer (pT₁₋₄).CONCLUSION: Urinary bladder cancer is in the majority in urinary bladder tumor in our country and transitional cell or urothelialcarcinoma compresses 98%. The male to female ratio in patients with bladder carcinoma is 3.9:1, older men over50 years are overweening affected.