ISSN: 0970-9371 eISSN: 0974-5165 |
Published by Medknow Publishers
VOL 27 NUMBER 1
- Application of pattern analysis in fine needle aspiration of solitary nodule of thyroid
Jyothi B Lingegowda, Prakash H Muddegowda, N Rajesh Kumar, R Ramkumar Kurpad
Journal of Cytology 2010 27(1):1-7
Background : Various methods are used to arrive at a conclusive diagnosis of thyroid lesions on fine needle aspiration cytology (FNAC). Systemic pattern analysis is one such that can be used to analyze the lesions and divide them into individual categories.
Aims : To study the application of pattern analysis in the interpretation of solitary thyroid nodule (STN).
Materials and Methods : Two hundred and nineteen cases of fine needle aspiration cytology of STN were reviewed along with histopathological correlation. Smears were classified based on primary and secondary patterns. Predominant pattern (primary) was identified and lesion categorized. This was followed by identifying the next dominant pattern (secondary) and recategorization. Cytological diagnosis based on primary and secondary patterns was correlated with the histopathological diagnosis.
Results : Based on pattern analysis, the study had a sensitivity of 66.7% and specificity of 98.9%. The positive predictive value and negative predictive value were 88.9% and 96% respectively and the overall diagnostic accuracy was 95.4%.
Conclusions : The present study demonstrates the feasibility and applicability of pattern analysis in diagnosing thyroid lesions by FNAC, which could be easily reproducible.
- Papillary lesions of breast - An introspect of cytomorphological features
D Prathiba, Shalinee Rao, Kasthuri Kshitija, Leena Dennis Joseph
Journal of Cytology 2010 27(1):12-15
Background : True papillary lesions of the breast have a significantly high error rate on fine needle aspiration cytology (FNAC), as many other nonpapillary breast lesions exhibit overlapping features on cytosmears.
Aim : To evaluate the utility of individual morphological features in offering a more precise cytodiagnosis in papillary lesions of the breast.
Materials and Methods : Cytology smears reported as papillary lesions on nipple discharge / FNAC and histopathology over a period of two years were studied and correlated. A subjective assessment of morphological features, namely, the cellular yield, presence of three-dimensional papillary clusters, stromal bare nuclei, presence of cyst macrophages and cellular atypia was carried out on cytosmears.
Results : Fourteen cases of papillary lesions were identified. Thirty-six per cent of the cases were found to be true positive, 43% false negative and 21% false positive with a sensitivity of 42% for papillary lesions. Eight of nine papillary lesions showed cyst macrophages. Stromal bare nuclei were seen in three of four malignant papillary lesions. However, the number of stromal bare nuclei was less compared to benign lesions. None of the malignant nonpapillary lesions showed stromal bare nuclei.
Conclusions : Cytomorphological features alone are inadequate for the precise diagnosis of papillary lesions of the breast.
VOL 27 NUMBER 2
- Synovial sarcoma with relevant immunocytochemistry and special emphasis on the monophasic fibrous variant
Radhika Kottu, Aruna K Prayaga
Journal of Cytology 2010 27(2):47-50
Background: Monophasic fibrous synovial sarcoma (SS) is the most common variant of SS. Only a few cytological studies are available on this entity. Bcl-2 protein expression has been described as a characteristic marker of SS and is useful for its differentiation from other sarcomas. Cytokeratin and CD99 are also used in detecting SS.
Aims: To evaluate synovial sarcoma and its variants cytomorphologically.
Materials and Methods: During a period of 10 years 7 months, i.e. from January 1998 to July 2008, 12 cytologic specimens diagnosed as synovial sarcoma were reviewed. Ten cases were diagnosed as SS on aspiration alone but two cases required ancillary technique i.e., immunocytochemistry staining with bcl-2 and cytokeratin. The smears were stained with Papanicolaou and May-Grόnwald-Giemsa stains.
Results: All cytologic specimens in our study had similar appearance. Most smears were highly cellular and were made up of densely packed tri-dimensional groups and singly scattered round to oval cells. Cellular monomorphism and vascular channels within the cell groups were the remarkable findings. Only one case showed cytologic evidence of epithelial differentiation. Bcl-2, cytokeratin, CD99 positivity was seen on immunohistochemistry staining. Results were categorized according to age, sex and morphologic variants.
Conclusions: Although cytomorphologic features of synovial sarcomas are characteristic enough to permit its recognition, clinical correlation is necessary for accurate diagnosis. Monophasic variant is the most common entity observed in the present study.
- Comparison of aspiration vs non-aspiration techniques in fine-needle cytology of thyroid lesions
Anil Kumar Maurya, Anurag Mehta, NS Mani, VS Nijhawan, Rajeev Batra
Journal of Cytology 2010 27(2):51-54
Aim: To compare the efficacy of fine-needle non-aspiration cytology (FNNAC) with that of fine-needle aspiration cytology (FNAC) of thyroid lesions.
Materials and Methods: FNAC and FNNAC techniques were studied in 50 cases of thyroid lesions. All the needle-sampling procedures were done by a single operator. The samples were assessed cytologically and evaluated using five parameters, that is, background blood or clot, amount of cellular material, degree of cellular degeneration, and degree of cellular trauma and retention of appropriate architecture.
Statistical Analysis: Wilcoxon signed rank test was performed using SPSS14 software. Differences between all the individual parameters as observed in FNAC and FNNAC smears were insignificant.
Results and Conclusion: After evaluation of FNAC and FNNAC on the basis of these scores, greater numbers of diagnostically superior samples were obtained by FNNAC; however, by FNAC more number of diagnostically adequate smears were observed. The numbers of unsuitable smears were also more by FNNAC technique.
- Cytological grading of breast cancers and comparative evaluation of two grading systems
Farooq Ahmed Wani, Subhash Bhardwaj, Dinesh Kumar, Pervez Katoch
Journal of Cytology 2010 27(2):55-58
Aim: To evaluate and compare the cytograding of breast cancers using Robinson's and Mouriquand's grading methods.
Materials and Methods: A 5-year retrospective (from Oct 2000 to Sept 2005) and 1-year prospective study (from Oct 2005 to Oct 2006). A total of 110 fine-needle aspiration cytology (FNAC) cases of breast cancers were studied. These were graded according to Robinson's and Mouriquand's grading methods (grade I-III) followed by comparison of the two methods.
Results: Of the 110 cases graded according to Robinson's method, 28 (25.45%) cases were grade I, 46 (41.81%) grade II, and 36 (32.72%) were grade III, whereas using Mouriquand's grading methods, 28 (25.45%), 42 (38.18%), and 40 (36.36%) cases were graded as grade I, II, and III, respectively. A high degree of concordance was observed between the two grading methods (90.9%). A highly significant relationship between the scores obtained by two methods was also observed (P=0.004).
Conclusions: A comprehensive cytological grading of breast cancers is possible by using two different methods proposed by Robinson and Mouriquand. In spite of a high degree of concordance between the two methods, the Robinson's grading system has been found to be easier and better because of more objective set of criteria and easy reproducibility.
- Distinction of phyllodes tumor from fibroadenoma: Cytologists' perspective
Ranjana Bandyopadhyay, Dipanwita Nag, Santosh Kumar Mondal, Subhalakshmi Mukhopadhyay, Sumit Roy, Swapan Kumar Sinha
Journal of Cytology 2010 27(2):59-62
Background: Fibroadenomas and phyllodes tumors may have similar cytological appearances. However, a detailed study of cytomorphology of stromal elements may be helpful in differentiation.
Aim: To evaluate the cytological features of phyllodes tumor in our study with special reference to features that can help distinguishing it from fibroadenoma.
Materials and Methods: The archival materials of our hospital were searched from January 2006 to January 2009 for histopathologically-diagnosed cases of phyllodes tumor. The cases in which previous cytopathology smears were available were included in the study. The cytomorphology of 10 such cases were compared with 25 cytologically-diagnosed and histopathologically-confirmed cases of fibroadenoma.
Results: The size, cellularity of stromal fragments, and the proportion of spindle cells in the background are important features in such differentiation.
- Hyalinizing trabecular tumor of the thyroid gland
Sumiti Gupta, Shilpi Modi, Veena Gupta, Nisha Marwah
Journal of Cytology 2010 27(2):63-65
Hyalinizing trabecular tumor (HTT) is an unusual and controversial lesion of the thyroid gland. Some have considered it a unique entity, some have considered it a variant of papillary carcinoma, and still others have considered it a nonspecific pattern that may be seen with a variety of thyroid lesions. The histological and ultrastructural characteristics of this thyroid neoplasm are well documented; however, its cytological diagnosis by fine needle aspiration cytology (FNAC) remains challenging. The cytomorphological features of this entity overlap with both papillary and medullary carcinoma to a varying extent. We report a case of HTT with cytological evaluation by FNAC in a 28-year-old male.
- FNAC diagnosis of medullary carcinoma thyroid: A report of three cases with review of literature
Ghazala Mehdi, Veena Maheshwari, Hena A Ansari, Lubna Sadaf, Mohammad Amanullah Khan
Journal of Cytology 2010 27(2):66-68
Medullary carcinoma of the thyroid is an unusual neoplasm, which is associated with specific supportive diagnostic markers. Despite this, its cytological diagnosis is often difficult. We report herewith three cases of medullary thyroid carcinoma. The diagnosis was established on fine-needle aspiration cytology. Plasmacytoid cell pattern was observed in two cases and spindle cell pattern in the third case.
- Adenoid cystic carcinoma of breast and the importance of differentiation from collagenous spherulosis by FNAC
Amrish N Pandya, Pinal Shah, RD Patel, Prashant R Patel
Journal of Cytology 2010 27(2):69-70
We are presenting a case of adenoid cystic carcinoma (ACC) of breast in a 66-year-old woman having lump in left breast, admitted to surgical ward of our institute. A diagnosis of ACC of breast was made and subsequently confirmed histopathologically and on immunohistochemistry.
- The cytology of micropapillary variant of colloid carcinoma of breast: A report of two cases
Jayashree Krishnamurthy, Divya Kota Nagappa
Journal of Cytology 2010 27(2):71-73
Colloid carcinoma (pure mucinous carcinoma) is an uncommon variant of breast carcinoma with distinctive cytological and histological features. These tumors are characterised by islands of tumor cells floating in a sea of abundant extracellular mucin. We present the cytology of two cases of colloid carcinoma occurring in 80-year-old and 45-year-old females. The fine-needle aspiration cytology helps to subcategorize the tumor type, thereby enhancing the knowledge about the distinctive cytological features of special and uncommon variants of breast carcinoma, their course and prognosis. A distinctive micropapillary variant of pure mucinous carcinoma which is rarely described, is represented in one of the cases. Also we report, here, colloid carcinoma in a female of reproductive age, a relatively uncommon occurrence.
- The cytology of molluscum contagiosum mimicking skin adnexal tumor
Jayashree Krishnamurthy, Divya Kota Nagappa
Journal of Cytology 2010 27(2):74-75
Molluscum contagiosum is a cutaneous viral infection presenting as multiple, umbilicated papules and vesicles. The cytology of molluscum contagiosum in an 11-year-old boy, which presented atypically as a solitary nodule over the right cheek, mimicking a skin adnexal tumor is reported here. Fine needle aspiration cytology plays a vital role in establishing the correct diagnosis of clinically unsuspected cases, and hence, the proper management of such lesions. The cytology of molluscum contagiosum is characterized by the presence of numerous large intracytoplasmic basophilic bodies that push the host nucleus to the periphery, giving a signet ring appearance to the superficial epidermal cells.
- Cytological diagnosis of squamous cell carcinoma of renal pelvis
Rubi Bindra, Saurav Gupta, Neelam Gupta
Journal of Cytology 2010 27(2):76-77
- Cytological diagnosis of peritoneal endometriosis
Sudheer Arava, Venkateswaran K Iyer, Sandeep R Mathur
Journal of Cytology 2010 27(2):77-78
- Microfilaria concomitant with metastatic deposits of adenocarcinoma in lymph node fine needle aspiration cytology: A chance finding
Sachin S Kolte, Rahul N Satarkar, Pratibha M Mane
Journal of Cytology 2010 27(2):78-80
VOL 27 NUMBER 3 (2010)
- Plasmacytoma of tonsil diagnosed by fine-needle aspiration cytology
Ramachandra V Bhat, KM Prathima, ML Harendra Kumar, GK Narayana
Journal of Cytology 2010 27(3):102-103
Extramedullary plasmacytoma of tonsil is rare. Even though biopsy is necessary for final diagnosis, fine-needle aspiration cytology (FNAC) can provide useful information in the management of such cases. We report a case of plasmacytoma of tonsil diagnosed by FNAC in a 43-year-old man who presented with a swelling in the right tonsillar area. FNAC smears revealed sheets of plasma cells at various stages of maturation. Subsequent histopathological and immunohistochemical studies confirmed the diagnosis of plasmacytoma. This case is reported for the rarity of site for extramedullary plasmacytoma and to highlight the usefulness of FNAC in lesions of tonsil.
- Cytodiagnosis of glomus tumor
Sumana Mukherjee, Gautam Bandyopadhyay, Sandeep Saha, Manoj Choudhuri
Journal of Cytology 2010 27(3):104-105
Glomus tumors are uncommon, with an estimated incidence of 1.6%. Cytological descriptions of this tumor are few. We report a 15-year-old boy presenting with a painful subungual swelling. Fine needle aspiration cytology showed uniform cells with homogeneous chromatin and scanty cytoplasm. Cytology was reported as "suggestive of glomus tumor". Histopathological examination confirmed the diagnosis. Careful cytomorphological examination supported by appropriate clinical history should suggest the diagnosis of glomus tumor and help in preoperative diagnosis.
- Scar endometriosis
Zaheer Abbas Ali Khan Pathan, US Dinesh, Ravikala Rao
Journal of Cytology 2010 27(3):106-108
Endometriosis is the presence of functioning endometrium outside the uterus. Endometriosis rarely occurs in the abdominal wall. Majority of abdominal wall endometriosis occur in or adjacent to surgical scars, following caesarean section or hysterectomy. Laparotomy scar endometriosis following salpingectomy for ectopic pregnancy has rarely been reported. We report a case of scar endometriosis following laparotomy for chronic ectopic, and diagnosed by fine needle aspiration cytology (FNAC). Excision biopsy confirmed the FNAC diagnosis of scar endometriosis.
- Aggressive digital papillary adenocarcinoma diagnosed by fine needle aspiration cytology
Jayashree Krishnamurthy, Bindu Patil
Journal of Cytology 2010 27(3):109-111
Aggressive digital papillary adenocarcinoma is a rare variant of eccrine sweat gland malignancy with a propensity for metastases and recurrence. We report a 45-year-old female with aggressive digital papillary adenocarcinoma diagnosed by fine needle aspiration cytology (FNAC). The cytological findings were representative of the histological features. The recognition of aggressive digital papillary adenocarcinoma as a distinct clinicopathological eccrine sweat gland neoplasm is important because of the potential for aggressive local growth and distant metastasis. FNAC plays an important role in the preoperative diagnosis and management of these lesions.
- Burkitts lymphoma of the small intestine: A cytological diagnosis
Journal of Cytology 2010 27(3):112-112
- Squash preparation: A reliable diagnostic tool in the intraoperative diagnosis of central nervous system tumors
Sumit Mitra, Mohan Kumar, Vivek Sharma, Debasis Mukhopadhyay
Journal of Cytology 2010 27(3):81-85
Background : Intraoperative cytology is an important diagnostic modality improving on the accuracy of the frozen sections. It has shown to play an important role especially in the intraoperative diagnosis of central nervous system tumors.
Aim: To study the diagnostic accuracy of squash preparation and frozen section (FS) in the intraoperative diagnosis of central nervous system (CNS) tumors.
Materials and Methods : This prospective study of 114 patients with CNS tumors was conducted over a period of
18 months (September 2004 to February 2006). The cytological preparations were stained by the quick Papanicolaou
method. The squash interpretation and FS diagnosis were later compared with the paraffin section diagnosis.
Results : Of the 114 patients, cytological diagnosis was offered in 96 cases. Eighteen nonneoplastic or noncontributory cases were excluded. Using hematoxylin and eosin-stained histopathology sections as the gold standard, the diagnostic accuracy of cytology was 88.5% (85/96) and the accuracy on FS diagnosis was 90.6% (87/96). Among these cases, gliomas formed the largest category of tumors (55.2%). The cytological accuracy in this group was 84.9% (45/53) and the comparative FS figure was 86.8% (46/53). In cases where the smear and the FS diagnosis did not match, the latter opinion was offered.
Conclusions : Squash preparation is a reliable, rapid and easy method and can be used as a complement to FS in the intraoperative diagnosis of CNS tumors.
- Role of scrape cytology in the intraoperative diagnosis of tumor
Sachin S Kolte, Rahul N Satarkar
Journal of Cytology 2010 27(3):86-90
Background : Rapid diagnosis of surgically removed specimens has created many controversies and a single completely reliable method has not yet been developed. Histopathology of a paraffin section remains the ultimate gold standard in tissue diagnosis. Frozen section is routinely used by the surgical pathology laboratories for intraoperative diagnosis. The use of either frozen section or cytological examination alone has an acceptable rate (93-97%) of correct diagnosis, with regard to interpretation of benign versus malignant.
Aim : To evaluate the utility of scrape cytology for the rapid diagnosis of surgically removed tumors and its utilisation for learning cytopathology.
Materials and Methods : 75 surgically removed specimens from various organs and systems were studied. Scrapings were
taken from each specimen before formalin fixation and stained by modified rapid Papanicolaou staining.
Results : Of the 75 cases studied, 73 could be correctly differentiated into benign and malignant tumors, with an accuracy rate of 97.3%.
Conclusions : Intraoperative scrape cytology is useful for intraoperative diagnosis of tumor, where facilities for frozen section are not available. The skill and expertise developed by routinely practicing intraoperative cytology can be applied to the interpretation of fine needle aspirate smears. Thus, apart from its diagnostic role, intraoperative cytology can become a very useful learning tool in the field of cytopathology.
- Image-guided fine-needle aspiration cytology of ovarian tumors: An assessment of diagnostic efficacy
Ghazala Mehdi, Veena Maheshwari, Sheerin Afzal, Hena A Ansari, Maryem Ansari
Journal of Cytology 2010 27(3):91-95
Background : Image-guided fine-needle aspiration cytology (FNAC) of ovarian lumps is being increasingly used for the successful diagnosis of ovarian tumors, although borderline cases may be difficult to diagnose by this method.
Aim : To demonstrate the efficacy of image-guided FNAC in diagnosing ovarian tumors (benign and malignant) and to evaluate the usefulness of cytology as a mode of easy and rapid diagnosis of ovarian lumps.
Materials and Methods : The study was conducted on 42 female patients. Clinical evaluation and relevant investigations were carried out. Diagnosis was established by FNAC performed under image guidance (ultrasonography/computed tomography). The cytological diagnosis was confirmed by histopathological examination.
Results : Cytological diagnosis was rendered on all the 42 ovarian lesions, with a correct diagnosis in 34 cases, resulting in a diagnostic accuracy of 80.9%. Most of the cases with discordant diagnoses were surface epithelial tumors of low malignant potential and required histopathological examination for a final diagnosis.
Conclusions : Image-guided FNAC is an inexpensive, rapid and fairly accurate procedure for the diagnosis of ovarian lesions. It provides a safe alternative to the more expensive, time consuming and cumbersome surgical route to diagnosis.
- Cytodiagnosis of chondromyxoid fibroma
Vaishali A Walke, Suprita P Nayak, Maitreyee M Munshi, Sudhakar K Bobhate
Journal of Cytology 2010 27(3):96-98
Chondromyxoid fibroma (CMF) is an unusual tumor that predominantly affects long bones of young adults. We present two cases of CMF that were diagnosed on cytology. The specific cytological features included varying combinations of chondroid, myxoid and fibroid elements. These features when correlated with clinico-radiological findings helped to arrive at a correct diagnosis. Thus a definitive diagnosis of CMF can be made on cytology based on which further line of treatment can be planned.
- The cytology of giant solitary trichoepithelioma
Jayashree Krishnamurthy, KN Divya
Journal of Cytology 2010 27(3):99-101
Giant solitary trichoepithelioma (GST) is a rare trichogenic tumor, which may present as a pigmented lesion. An 80-year-old man was diagnosed to have giant solitary trichoepithelioma on fine-needle aspiration cytology. The cytological findings represented the histological features. The recognition of GST is important because of its close resemblance to basal cell carcinoma and other skin adnexal tumors - clinically, cytologically and histologically.
VOL 27 NUMBER 4 (2010)
- Morphologic and cytomorphometric analysis of exfoliated buccal mucosal cells in diabetes patients
H Prasad, V Ramesh, PD Balamurali
Journal of Cytology 2010 27(4):113-117
Background : It is now known that the disease process of diabetes has effects on various tissues of the body. The following study was done to analyze the effects of diabetes on oral tissues.
Aims : To study the morphology and cytomorphometry of the cells obtained in cytologic smears from the buccal mucosa of diabetic patients.
Materials and Methods : Smears were obtained from clinically normal buccal mucosa of 50 randomly selected diabetic patients attending the diabetic clinic and the out-patient department and of five healthy subjects as control. Smears were stained using Papanicolaou method, and using a micrometer mean values of nuclear diameter (ND), cell diameter (CD), cytoplasmic diameter (CyD) and nucleus: cytoplasm ratio (N: C ratio) were obtained for each patient. Diabetic patients were divided into four groups based on the glycosylated hemoglobin (GHb) values for comparison.
Statistical analysis used : Student's T-test and Fisher's F-test.
Results : Statistically significant increase in ND (P=0.0367) was found in diabetic patients compared to controls. Degree of glycemic control significantly affected ND (P=0.0042) and N: C ratio (P=0.0055). In general, as the severity of diabetes increases, ND and N: C ratio rise gradually.
Conclusions : Diabetes produces definite morphologic and cytomorphometric changes in the buccal mucosa of patients. However, further research in this direction is indicated, to analyze the significance of these findings as a tool for diabetes detection, as well as to obtain deeper insights into its effects on various tissues.
- Study of cytomorphology of solid pseudopapillary tumor of pancreas and its differential diagnosis
Neelam Mehta, Lopa Modi, Trupti Patel, Manoj Shah
Journal of Cytology 2010 27(4):118-122
Background: Solid pseudopapillary tumor is a rare pancreatic neoplasm with uncertain to low malignant potential. This is an uncommon neoplasm with many pseudonyms, occurring predominantly in young woman under the age of thirty years.
Aims: To study the cytomorphological features of six cases of solid and pseudopapillary epithelial neoplasm of pancreas diagnosed on fine needle aspiration cytology (FNAC) in years 2005 to 2007 and its cyto-histological correlation.
Materials and Methods: Image-guided FNAs was done in these six patients preoperatively. Alcohol-fixed smears were stained with Papanicolaou stain, cytomorphological findings were evaluated and diagnosis was made. Diagnosis was later confirmed by histology in all cases.
Results: All six cases show characteristic cytological features such as hypercellular smears with presence of abundant delicate papillary fragments, dyscohesive cells, monomorphic tumor cells with delicate folded nuclear membranes, and foamy macrophages in the background.
Conclusions: Preoperative correct diagnosis of solid pseudopapillary tumor of pancreas is possible on FNAC and by doing so it helps in management of this surgically curable neoplasm.
- Cytomorphological spectrum of subcutaneous and intramuscular cysticercosis: A study of 22 cases
Meenu Gill, Shivani Dua, PS Gill, Veena Gupta, Sumiti Gupta, Rajiv Sen
Journal of Cytology 2010 27(4):123-126
Background: Cysticercosis is more common than usually thought. Fine needle aspiration cytology (FNAC) plays an important role in prompt recognition of this disease.
Aims: To study the role of FNAC in the diagnosis of cysticercosis.
Materials and Methods: Twenty-two patients with subcutaneous and intramuscular nodules, who were clinically diagnosed as tuberculous lymphadenitis, reactive lymphadenitis, lipoma, neurofibroma and cysticercosis were included in the present study.
Results: In nine cases, a definitive diagnosis of cysticercosis was obtained in the form of fragments of parasite bladder wall and, biopsy confirmed the diagnosis. In the rest 13 cases, larval fragments could not be identified on the aspirates and the diagnosis of parasitic inflammation was suggested on the basis of other cytomorphological findings. Follow-up biopsy confirmed the diagnosis of cysticercosis.
Conclusions: FNAC in cysticercosis is a low-cost outpatient procedure. The cytological diagnosis is quite straightforward in cases where the actual parasite structure is identified in the smears. However, in other cases, presence of eosinophils, histiocytes which may be in palisaded clusters or not, a typical granular dirty background, etc., are the features which should always alert the pathologist to this possibility.
- A cell pattern approach to interpretation of fine needle aspiration cytology of thyroid lesions: A cyto-histomorphological study
Basavaraj P Bommanahalli, Ramachandra V Bhat, R Rupanarayan
Journal of Cytology 2010 27(4):127-132
Aim: Our study aimed at a cell pattern approach to interpret thyroid cytology and to demonstrate diagnostic accuracy of fine needle aspiration cytology (FNAC) with an emphasis on diagnostic pitfalls.
Materials and Methods: A total number of 218 goitre cases, from the year 2000 to 2004, were reviewed retrospectively from the cytology files, without considering the previous cytological diagnosis. Four cases with inadequate aspirate were excluded. The predominant cell pattern, such as macro/normofollicular, microfollicular, papillary, syncytial, dispersed and cystic pattern, was noted in each case. The final diagnosis was arrived by observing the cellular details and background elements. Cytological diagnosis was correlated with histopathology in 75 cases. The sensitivity and specificity were computed.
Results: Normo/macrofollicular pattern was seen in 71.96% of nodular goitre and 6.9% of follicular neoplasms. Around 86.2% of follicular neoplasms and 17.6% of papillary carcinoma had microfollicular pattern. The papillary pattern was seen in 47% of papillary carcinoma. Syncytial pattern was noticed in 72.3% of chronic lymphocytic thyroiditis and 29.4% of papillary carcinoma. Cytological diagnosis was concordant with histopathological diagnosis in 65 cases. Overall sensitivity and specificity of FNAC in diagnosing neoplastic lesions of thyroid were 83.33 and 95.55%, respectively.
Conclusion: FNAC is more sensitive and specific in triaging neoplastic from non-neoplastic thyroid lesions. Identification of the predominant cell pattern would be complementary to analysis of cell morphology and background details in cytological diagnosis of thyroid lesions. This approach helps to diagnose follicular neoplasm and follicular variant of papillary thyroid carcinoma.
- Eumycetoma versus actinomycetoma: Diagnosis on cytology
Nishat Afroz, Nazoora Khan, Farhan A Siddiqui, Mehar Rizvi
Journal of Cytology 2010 27(4):133-135
Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi producing specific colored granules known as grains. A 45-year-old farmer presented clinically with a left foot mass with multiple discharging sinuses existing for last 3 years. Clinical and radiological findings suggested a diagnosis of chronic osteomyelitis with suspicion of tuberculosis. Imprints plus fine needle aspiration cytology (FNAC) smears exhibited distinct brown-black colonies of a fungus having branching and septate hyphae embedded in matrix like material against a mixed inflammatory background. Periodic acid Schiff (PAS) stain gave positive staining and subsequent fungal culture confirmed the cytological diagnosis and aided in species identification as Madurella mycetomatis. Thus, eumycetoma can precisely be diagnosed and confidently differentiated from similar conditions such as actinomycetoma by simple and inexpensive cytological techniques such as FNAC and imprint smears, employing routine May-Grόnwald-Giemsa, Papanicolaou and simple PAS stains on cytological specimen, thus leading to rapid diagnosis for institution of correct treatment.
- Retroperitoneal cystic schwannoma: A case report with review of literature
Aparna Narasimha, ML Harendra Kumar, R Kalyani, M Madan
Journal of Cytology 2010 27(4):136-139
The occurrence of retroperitoneal schwannoma is uncommon and its presence may only be expressed by insidious onset of nonspecific symptoms such as vague abdominal pain. Imaging modalities like computed tomography and magnetic resonance imaging may demonstrate the tumor, but due to heterogeneity and degeneration in some tumors, it may mimic malignancy. So, fine needle aspiration cytology followed by tissue sampling through needle biopsies may be essential to confirm the diagnosis prior to the surgery. This case is reported for its rare clinical presentation, having duration of more than 40 years with cystic degenerative changes.
- Scrape cytology in the early diagnosis of eyelid sebaceous carcinoma
CA Arathi, C Vijaya
Journal of Cytology 2010 27(4):140-142
The low incidence and the non-specific clinical symptoms led us to conclude that the diagnosis of a sebaceous carcinoma of the eyelid often occurs very late. Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which can exhibit aggressive local behavior, can have pagetoid spread and can metastasize to regional lymph nodes and distant organs. The neoplasm is known to masquerade as other benign and less malignant lesions, and has relatively high morbidity and mortality. Scrape cytology was done in a 70-year-old female with a tumor in left upper lid. Cytological smears were suggestive of sebaceous carcinoma. Subsequently, histopathology confirmed the diagnosis of sebaceous gland carcinoma. The article highlights the role of scrape cytology in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma, to prevent recurrence and metastasis.
- Cytomorphological features of Hürthle cell carcinoma: A report of two cases with review of literature
Kavita Mardi, Neelam Gupta, Sudarshan Sharma, Lalita Negi
Journal of Cytology 2010 27(4):143-145
The use of the term "Hürthle cell neoplasm" as the gold standard should be discouraged as it makes evaluating these lesions more confusing. Recently, a number of studies have been conducted to define criteria that are more specific for Hürthle cell carcinoma (HCC). We herein report two cases of HCC of thyroid which were accurately diagnosed preoperatively using various cytological features described in the recent studies. A review of the literature is also presented.
- Fine needle aspiration cytology diagnosis of paravertebral extraosseus Ewing's sarcoma
Archana C Buch, NK Panicker, Sweta Sarawagi, Sampada Anwekar, Amit T Kharat
Journal of Cytology 2010 27(4):146-148
Extraskeletal Ewing's sarcoma (EES) is a rare tumor. Paravertebral Ewing's sarcoma requires more extensive therapy as compared to Ewing's sarcoma of bone. Fine needle aspiration cytology (FNAC) plays an important role in the early diagnosis of these cases. We present a case where paravertebral extraosseous Ewing's sarcoma was diagnosed on FNAC in a 19-year-old girl.
- Osseous differentiation in cystosarcoma phyllodes - diagnosed by fine needle aspiration cytology
Journal of Cytology 2010 27(4):149-151
Osseous differentiation within a phyllodes tumor is extremely rare. Cytological and histological findings of a case of malignant phyllodes tumor with osseous differentiation are presented. A 45-year-old female had a malignant phyllodes tumor with osseous stroma diagnosed by fine needle aspiration cytology. The cytological findings were representative of the histological features. The diagnosis of these tumors preoperatively is important in planning the most appropriate treatment. It is also important to follow up these patients postoperatively for long periods for recurrence and metastasis.
- Cytologic picture of Castleman's disease: A report of two cases
Ayyagari Sudha, Namala Vivekanand
Journal of Cytology 2010 27(4):152-154
Castleman's disease (CD), also called giant lymph nodal hyperplasia, is a lymphoproliferative disorder secondary to lymphoid follicle hyperplasia and marked capillary proliferation with endothelial hyperplasia. It presents as enlarged lymph nodes in the mediastinum, neck, groin, axilla and other sites. On clinical examination as well as gross examination, this disease mimics lymphomas and tuberculosis. Since cytological appearances vary depending on the type and extent of hyperplasia, fine needle aspiration cytology (FNAC) findings may not always be conclusive in all cases. We studied aspirates in two cases of CD, one of which presented with multiple enlarged axillary lymph nodes and the other with enlarged cervical lymph node. Cytology revealed reactive lymphadenitis with hyalinized capillaries and other features. Lymph node excision in both cases confirmed the diagnosis.
- Microfilaria in cytology smears from upper arm swelling
Ruma Pahwa, Vivek Mohan Arora
Journal of Cytology 2010 27(4):155-155
- Lymphatic filariasis: Aspiration of adult gravid female worm from a soft tissue swelling
Kalpana Azad, Rashmi Arora, Kusum Gupta, Uma Sharma
Journal of Cytology 2010 27(4):156-157
VOL 28 NUMBER 1 (2011)
- Fine needle aspiration cytology of pilomatrixoma
Cherry Bansal, Uma Handa, Harsh Mohan
Journal of Cytology 2011 28(1):1-6
Aim : To delineate and characterize the cytomorphologic features of pilomatrixoma (PMX) helpful in correct diagnosis of the lesion on fine needle aspiration cytology (FNAC).
Materials and Methods : Archival records of clinical findings, FNAC and histopathological reports of PMX cases were analyzed. Aspirate findings in 14 cases of PMX were correlated with detailed clinical data and subsequent histopathology on excisional biopsy. Different morphological findings were graded semiquantitatively from 0 to 3+.
Results : The series showed female preponderance, with head and neck being the commonest site. Majority patients had a single tumor with mean size of 1.6 cm. Out of 14 biopsy proven cases of PMX, cytology findings revealed PMX in 7 cases on the basis of ghost cells, groups of basaloid cells, squamous cells in combination with multinucleated giant cells and calcium deposits in a background of debris. The main reasons for erroneous diagnosis were predominance of one component over the others and non-representative aspirated material.
Conclusions : The cytological features of PMX are characteristic and allow a conclusive diagnosis provided the smears are examined keenly bearing in mind the diagnostic traps that can mislead a cytopathologist.
- The value of systematic pattern analysis in FNAC of breast lesions: 225 cases with cytohistological correlation
Prakash H Muddegowda, Jyothi B Lingegowda, Ramkumar Kurpad, PG Konapur, AS Shivarudrappa, PM Subramaniam
Journal of Cytology 2011 28(1):13-19
Background : Fine needle aspiration cytology (FNAC) has a high rating in the assessment of breast lesions. Various methods have been used to diagnose cytology of breast lesions.
Aims : Present study was undertaken to evaluate the feasibility of application of systematic pattern analysis based on morphology in diagnosing breast aspirates.
Materials and Methods : This is a retrospective study of FNAC of the breast done over a period of 4 years in a tertiary care centre. A total of 225 cases of breast lesions for which FNAC was done with histological follow-up were included in the study. Breast aspirates were provisionally diagnosed based on systematic pattern analysis. Aspirates were grouped into six categories based on predominant cellular pattern, and correlation between cytological and histological diagnosis was assessed.
Results : Application of pattern analysis on FNAC of breast lesions in our study had a sensitivity of 94.5%, specificity of 98%, diagnostic accuracy of 97%, positive predictive value of 95.8%, and negative predictive value of 97.4%.
Conclusions : Systematic pattern analysis based on morphology of FNAC smears was found to be highly reliable and could be easily reproducible in the assessment of breast masses.
- Guided fine needle aspiration cytology of retroperitoneal masses - Our experience
Mimi Gangopadhyay, Nirmal Kumar Bhattacharyya, Sailes Ray, Subrata Chakrabarty, Narayan Pandit
Journal of Cytology 2011 28(1):20-24
Background : Early pathological classification of retroperitoneal masses is important for pin-point diagnosis and timely management.
Aims : This study was done to evaluate the usefulness and drawbacks of guided fine needle aspiration cytology (FNAC) of retroperitoneal masses covering a period of two years with an intention to distinguish between neoplastic and non-neoplastic lesions and to correlate with histologic findings.
Materials and Methods : FNAC was done under radiological guidance in all cases using long needle fitted with disposable syringe. Appropriate staining was done and cytology was correlated with histology which was taken as the gold standard for comparison.
Results : Fifty-one patients who presented with retroperitoneal masses were studied. Forty-four lesions were malignant cytologically and 7 were inflammatory (tuberculous). According to radiological and cytologic findings, we classified our cases into four groups: renal tumors, retroperitoneal lymphadenopathy, germ cell tumors, soft tissue tumors. Except for cases of non-Hodgkin lymphoma (NHL) and metastatic lesions, we had sensitivity and specificity of 100%. In NHL the sensitivity and specificity were both 50%. In cases of metastatic adenocarcinoma, the sensitivity and specificity were 84.6% and 81.8%, respectively.
Conclusions : Ignoring the pitfalls, guided FNAC is still an inexpensive and reliable method of early diagnosis of retroperitoneal lesions.
- Cytodiagnosis of coexistent cryptococcal and mycobacterial lymphadenitis in a case of AIDS
Arti R Anvikar, Alka V Gosavi, Medha P Kulkarni, DN Lanjewar
Journal of Cytology 2011 28(1):25-27
Multiple infections are a common feature of acquired immunodeficiency syndrome (AIDS), but coexistent infections at the same site are rare. In this report, we describe a 35-year-old human immunodeficiency virus infected male with coexistent cryptococcal and mycobacterial lymphadenitis. He presented with generalised lymphadenopathy. Fine needle aspiration cytology of enlarged cervical lymph node, aided by special stains, revealed coexistent cryptococcal and mycobacterial infection. Coexistent infections pose diagnostic problems in AIDS patients and are likely to be missed. Special stains are valuable for accurate diagnosis of coexistent infections.
- Cytological diagnosis of adamantinoma of long bone in a 78-year-old man
Mimi Gangopadhyay, Raghunath Pramanik, Subrata Chakrabarty, Pranati Bera
Journal of Cytology 2011 28(1):28-29
A clinicohistopathological study of a rare case of adamantinoma of long bone in a 78-year-old patient is presented. The cytological features when evaluated in conjunction with clinical and radiologic features are sufficiently diagnostic. The primary knowledge of its existence and knowledge of its cytological features are important for a correct preoperative cytological diagnosis.
- Cytodiagnosis of cutaneous metastasis from renal cell carcinoma: A case report with review of literature
Vishal Dhingra, Vatsala Misra, Anthony P Singh, Stuti Agarwal
Journal of Cytology 2011 28(1):30-32
Cytodiagnosis of cutaneous metastasis of renal cell carcinoma (RCC) in the absence of history of primary tumor is difficult as it can be confused with other clear cell tumors. We report here a case of cytodiagnosis of cutaneous metastasis of RCC in a patient who had nephrectomy done 9 years back at some other centre, but did not have any records with him. Clinicians should be aware of the possibility of primary internal organ malignancy in patients presenting with cutaneous lesions and therefore conduct a careful examination and get necessary investigations. Prompt diagnosis and treatment will have its bearing on the eventual outcome.
- Metastatic myxoid liposarcoma of lung and mediastinum diagnosed by fine needle aspiration
Renuka V Inuganti, Saila G Bala, Krishna Y Bharathi
Journal of Cytology 2011 28(1):33-35
Myxoid liposarcomas metastatic to lungs and mediastinum are infrequent lung neoplasms. The tumor has an aggressive course and needs to be recognized cytologically. A 60-year-old male smoker presented with gradually progressive left-sided chest pain, cough, and expectoration for the past one month. Chest radiograph and computed tomography of thorax revealed a lung mass in left apical region extending into the posterior mediastinum, which was subjected to ultrasound-guided fine needle aspiration (FNA). Smears showed a cellular tumor with ovoid to spindle shaped tumor cells in a myxoid background having a rich vascular network. The possibility of a myxoid liposarcoma metastatic to lung and mediastinum was suggested and confirmed by histopathology. A previous history of excision of a tumor in the thigh one and half years ago was present. The importance of recognizing the cytological picture by FNA is discussed.
- Hemophagocytic syndrome secondary to cytomegalovirus infection in an infant
Anshu Gupta, Rajiv Sen, Charu Batra, Dipankar Banerjee, Anjali Gupta, Medha Jain
Journal of Cytology 2011 28(1):36-38
Virus associated hemophagocytic syndrome is a non-neoplastic, generalized histiocytic proliferation with prominent hemophagocytosis associated with a systemic viral infection. We report a case of cytomegalovirus (CMV) associated hemophagocytic syndrome in a 2 month old male child presenting with rashes, fever, hepatosplenomegaly, cervical lymphadenopathy and pancytopenia. Fine needle aspiration cytology and biopsy from cervical lymph nodes revealed prominent hemophagocytosis. Serology for CMV IgM was positive in both the mother and the child, suggesting recent infection. Possibly there was intrauterine transmission of the infection.
- Fine needle aspiration cytology and cell block in the diagnosis of seminoma testis
Abhishant Pandey, NM Nandini, AK Jha, GV Manjunath
Journal of Cytology 2011 28(1):39-41
Testicular neoplasms which show a wide variety of morphologic types, comprise a small proportion of malignancies. Early identification and treatment is essential for achieving long term survival. The cytologic findings in fine needle aspiration smears from left testicular swelling of a 49 year old male suggestive of a germ cell tumor was complimented by cell block preparation as seminoma. This was confirmed by histopathologic studies. We are presenting this case to emphasize that cell block can be used for diagnosis of testicular tumors.
- Mucinous carcinoma of breast: Cytodiagnosis of a case
Sangeeta Sharma, Rani Bansal, Anjali Khare, Nivesh Agrawal
Journal of Cytology 2011 28(1):42-44
Mucinous carcinoma of the breast is a relatively rare, pure form accounting for 2% of all breast cancers. Pure mucinous carcinoma of the breast has a favorable prognosis. The common age is postmenopausal group. Here, we report a 30-year-old female patient diagnosed on cytology as mucinous carcinoma of the breast with lymph node metastasis and subsequently confirmed by histopathology. In 1 year follow-up, the patient did not show pulmonary or distant metastasis and received adjuvant chemotherapy at every 3 weeks interval.
- Micronuclei: An essential biomarker in oral exfoliated cells for grading of oral squamous cell carcinoma
Kiran Jadhav, Nidhi Gupta, BR Ahmed Mujib
Journal of Cytology 2011 28(1):7-12
Background : Micronuclei in exfoliated oral epithelial cells have been shown in some studies to correlate with severity of this genotoxic damage. This severity can be measured in terms of grading of the lesions.
Aim : To correlate frequency of micronuclei (MN) in oral exfoliated cells in clinically diagnosed cases of oral squamous cell carcinoma (OSCC) followed by a histopathological grading.
Materials and Methods : The study subjects consisted of clinically diagnosed cases of OSCC. Healthy subjects without any tobacco consumption habits formed the control group. The cytosmears from both groups were stained with rapid Papanicolaou stain. MN were identified according to the criteria given by Countryman and Heddle with some modifications.
Results : The frequency of MN was three to four times higher in patients with OSCC as compared to patients in the control group and the difference was found to be highly significant. In 75% cases, the cytological grade as determined by the frequency of micronuclei correlated with the histopathological grade and this observation was statistically significant.
Conclusions : MN can be a candidate to serve as a biomarker for prediction of the grade of OSCC.
VOL 28 NUMBER 2 (2011)
- Needle stick injuries during fine needle aspiration procedure: Frequency, causes and knowledge, attitude and practices of cytopathologists
Neeta Kumar, Prashant Sharma, Shyama Jain
Journal of Cytology 2011 28(2):49-53
Background: There is no study available on the frequency, predisposing factors and outcome of needle stick injury (NSI) in cytopathologists who perform fine needle aspiration (FNA).
Aim: To know the frequency, circumstances and sequlae of NSI sustained by cytopathologists, assess their knowledge about risks of NSI and attitudes and practices towards use of standard precautions and post-injury wound care.
Materials and Methods: Study design: cross sectional. Setting: Tertiary care teaching and non-teaching hospitals and private laboratories. Data collection method: Knowledge, attitude and practices survey using a questionnaire.
Results: Majority (90.5%) of the respondents have had NSI in their total career. In the previous year, more than half (71.4%) had at least one NSI (mean 3.2). NSI was the most common in index finger of non-dominant hand (59.6%) and occurred during step two of FNA procedure when the needle was being manipulated within the lump. The major predisposing factors were uncooperative patients (88.9%), small children (54%), deep masses (36.5%), hot humid climate (88.9%), heavy workload (76.2%) and poor administrative arrangement (54%). The adherence to standard precautions was not optimal (74.6%). None of them reported NSI to the authorities, nor investigated source patient or themselves. 82.5% of the respondents were not aware of any formal exposure reporting system in their hospital.
Conclusion: Cytopathologists frequently experience NSI while performing FNA. Frequency of injury is also related to patient characteristics and work site factors. Education and motivation for adhering to standard precautions and post-exposure prophylaxis are often lacking.
- Her-2 neu (Cerb-B2) expression in fine needle aspiration samples of breast carcinoma: A pilot study comparing FISH, CISH and immunocytochemistry
Kusum Kapila, S Al-Awadhi, IM Francis
Journal of Cytology 2011 28(2):54-56
Background: Breast cancers with Her-2 neu gene amplification are recognized as important markers for aggressive disease and targets which respond to therapy with trastuzumab. Her-2 neu testing on histological sections is routinely performed to select patients who may benefit from anti- Her-2 neu therapy. Few reports are available which document Her-2 neu status on fine needle aspirates (FNA).
Aim: This pilot study is to document expression of Her-2 neu (Cerb-B2) on cytospin smears from FNA of patients with breast carcinoma.
Materials and Methods: Twenty samples of FNA already collected for diagnostic purposes from patients with primary breast carcinoma were studied for demonstration of Her-2 neu expression by immunohistochemistry (IHC), Fluorescent in-situ hybridization (FISH) and chromogenic in-situ hybridization (CISH) on cytospin smears from FNA. Their expression was compared with tissue sections where possible.
Results: Good correlation was observed between Her-2 neu protein expression and gene amplification in cytospin smears. Three of five (60%) breast carcinomas cases with 2+ and 3+ staining on IHC showed gene amplification by FISH and CISH. Three of 7 (43%) and 5 of 7 (71%) cases negative/1+ staining on IHC did not show gene amplification by FISH and CISH respectively. Tissue sections from 10 cases with 2+ and 3+ staining for Her2neu by IHC showed gene amplification in 8 cases.
Conclusion: Demonstration of Her-2 neu by IHC, FISH or CISH in FNA is possible and may play a role in the management of patients with advanced breast cancer or those cases where surgical resection is not advisable.
- Cell Cannibalism: A cytological study in effusion samples
Cherry Bansal, Vandana Tiwari, US Singh, AN Srivastava, JS Misra
Journal of Cytology 2011 28(2):57-60
Background: Cytological examination of effusion fluid is a relatively easy and quick method for the diagnosis of primary or secondary malignancy.
Aims: To analyze the cytological significance of cell cannibalism in malignant effusion samples.
Materials and Methods: A retrospective review of 100 cases of malignant effusion was done. These 100 cases included 50 cases of contiguous, local spread to pleural/ascitic fluid. The remaining 50 cases were of disseminated malignancy. Effusions due to hematolymphoid malignancies were excluded. Smears from these cases were assessed for the presence of cell cannibalism, tumor cell within a tumor cell.
Results: The cannibalistic cells were more common in effusions with disseminated malignancy (nine out of 50 cases i.e. 18%) compared with cases of contiguous, local spread (two out of 50 cases i.e. 4%). Chi square test showed this difference to be statistically significant (x2 5.005, P=0.025). The majority of the cases were of carcinoma lung (6/11). Cytomorphologically, histiocytes displaying phagocytosis can simulate tumor cells and need to be distinguished.
Conclusions: Presence of cell cannibalism in malignant effusions is more often an indicator of disseminated malignancy with secondaries and higher tumor stage. Furthermore, cannibalism may provide a reliable predictor of progression of tumor from primary to the metastatic site.
- FNAB of metastatic lesions with special reference to clinicopathological analysis of primary site in cases of epithelial and non-epithelial tumors
Shamshad Ahmad, Kafil Akhtar, Swati Singh, Shahid Siddiqui
Journal of Cytology 2011 28(2):61-65
Aims: To ascertain the cytological diagnosis of metastatic lesions with special reference to the clinicopathological analysis of the primary site in cases of epithelial and non-epithelial tumors.
Materials and Methods: One hundred seventy-one suspected metastatic lesions were aspirated with a 22-23G needle and the smears were fixed and stained. The cases in which the primary site was not evident at the time of initial presentation were subsequently subjected to thorough physical examination followed by radiological investigations for the search of the primary site. Histopathological examination was performed in 16 cases with inconclusive cytological impression.
Observations: Of the total cases of metastatic lesions, 155 cases (90.6%) were diagnosed by fine needle aspiration biopsy and 16 cases (9.4%) by histopathology. The majority of the cases, 81 (47.4%), were observed in the fifth decade of life, followed by 76 cases (44.4%) in the sixth decade and 11 cases (6.4%) in the seventh decade of life. Lymph nodes were the most frequent site of metastasis in 115 cases (67.3%), with the majority in the cervical group. The oropharynx, including the oral cavity and pharyngolarynx, was observed to be the most common primary site, 55 cases (32.2%).
Conclusion: The most critical aspect of the evaluation of metastatic cases is the accurate pathologic assessment of the malignant tissues in conjunction with pertinent clinical data. Such close collaboration between the clinician and the pathologist may maximize the diagnostic potential in treatable primary tumors.
- Quantitative cytomorphometric analysis of exfoliated normal gingival cells
Punit Vaibhav Patel, Sheela Kumar, Veerendra Kumar, GD Vidya
Journal of Cytology 2011 28(2):66-72
Background: The use of oral exfoliative cytology as a diagnostic aid accentuates the need for establishing an accurate baseline, thereby enabling the comparison of abnormal oral tissue with established baseline.
Aims and Objective: To detect any changes in the nuclear area (NA), cytoplasmic area (CA), and nuclear:cytoplasmic ratio (N:C ratio) values for clinically normal gingival smears in relation to age and sex of apparently healthy subjects.
Materials and Methods: Gingival smears were collected from 80 (40 male, 40 female) apparently healthy subjects belonging to the age group of 0-20, 21-40, 41-60, and more than 60 years. Smear slides were fixed by using spray fixative. The smears were stained using Papanicolaou procedure. The cytoplasmic and NAs were measured using image analysis software. Statistical analysis of the data was done using one-way ANOVA with Tukey-HSD procedure and Student's t test.
Results: The result showed that there was a significant difference (P <0.001) in NA, CA, and N:C in males of different age groups. There was a significant difference (P <0.001) in NA, CA, and N:C in females of different age groups. The difference in N:C between males and females was significant (P <0.001) in all the groups. The difference in NA, CA, and N:C with age irrespective of gender was significant (P <0.05). There was a significant difference (P <0.05) between males and females with respect to NA, CA, and N:C irrespective of age.
Conclusion: Age-and sex-related alterations were observed in gingival smears, which could be a baseline for these variables to compare identical measurements, made on pathologic smears of oral premalignant and malignant lesions.
- Intraparenchymal clear cell ependymoma
Prabal Deb, V Manu, H Pradeep, Harjinder Singh Bhatoe
Journal of Cytology 2011 28(2):73-76
Clear cell ependymoma (CCE) is an uncommon variant of ependymoma having a predilection for the supratentorial region. Histologically, it bears an uncanny resemblance to oligodendroglioma, central neurocytoma, hemangioblastoma and metastasis from clear cell carcinoma. Here, we report a rare case of clear cell ependymoma in a 45-year-old male, which histomorphologically resembled anaplastic oligodendroglioma on intraoperative smears, frozen section and routine light microscopy. Immunohistochemistry, however, helped to arrive at the correct diagnosis. Unlike other clear cell tumors of the brain parenchyma, CCE is known to follow an aggressive course and, hence, obtaining a correct diagnosis is imperative since it has a direct therapeutic and prognostic connotation.
- Imprint cytology of the chromophobe renal cell carcinoma: Correlation with the histological and ultrastructural features
Journal of Cytology 2011 28(2):77-80
Chromophobe renal cell carcinoma (ChRCC) is a unique entity of renal cell carcinoma and has a low malignant potential. A correct cytological diagnosis can help to decide the suitable management and operation. I present here a case with an imprint cytology of ChRCC focusing on the correlation with the histological and ultrastructural features. A 69-year-old male underwent partial nephrectomy and imprint cytology. The cellular smear consisted of predominantly granular eosinophilic cells with round nuclei, a well-defined cytoplasmic membrane and accentuated cell borders. The cytoplasm was characterized by variable granularity with reticulated clearing or vague perinuclear vacuolization. Distinct perinuclear halos were infrequently noted. The histological, immunohistochemical and ultrastructural findings were compatible with ChRCC.
- Fine-needle aspiration diagnosis of extranodal non-Hodgkin's lymphoma of the tongue
Srinivasa Murthy, C Panduranga
Journal of Cytology 2011 28(2):81-83
Primary non-Hodgkin's lymphoma (NHL) of the oral region is rare. Oral manifestation is present in 3-5% of cases of NHL and oral lesions are rarely the initial manifestations. We describe primary NHL, diffuse, mixed, small and large cell type in a 50-year-old female, who presented with mass lesion primarily involving the base of the tongue; initially diagnosed by fine needle aspiration cytology and later confirmed by histopathology and immunohistochemistry. Pertinent literature is being reviewed.
- Mucinous carcinoma in a male breast
Roopak Aggarwal, Rajni , Geetika Khanna, Shaham Beg
Journal of Cytology 2011 28(2):84-86
Male breast cancer is rare as compared to female counterpart. Pure mucinous carcinoma is an extremely rare histological subtype representing less than 1% of male breast cancers. So far very few cases of pure mucinous carcinoma of male breast have been reported in the literature, most of which were diagnosed after surgical resection. Fine-needle aspiration cytology is a well-established procedure for the evaluation of female breast masses but the diagnosis of malignancy in aspirates from male breast masses is rare. We herein present one case of mucinous carcinoma of breast in a 75-year-old male diagnosed by fine-needle aspiration and confirmed by histopathology. After a follow-up of 12 months the patient is free of any recurrence or metastasis.
- Cytologic features of abscessified anaplastic large cell lymphoma
Navarro Antonia, Alvarez Melani, Jose A Jiménez-Heffernan
Journal of Cytology 2011 28(2):87-88
- Schaumann body in a case of sarcoidosis diagnosed on transbronchial FNAC
Nalini Gupta, Arvind Rajwanshi, Dheeraj Gupta
Journal of Cytology 2011 28(2):88-89
- Presacral chordoma diagnosed by transrectal fine-needle aspiration cytology
Harish S Permi, HL Kishan Prasad, S Veena, S Teerthanath
Journal of Cytology 2011 28(2):89-90
- Primary neuroendocrine carcinoma of breast
Sunita Singh, Garima Aggarwal, Sant P Kataria, Rajnish Kalra, Amrita Duhan, Rajeev Sen
Journal of Cytology 2011 28(2):91-92
VOL 28 NUMBER 3 (2011)
- Fine needle aspiration cytology of epididymal nodules
Vinaya B Shah, Tanuja M Shet, Shilpa K Lad
Journal of Cytology 2011 28(3):103-107
Background: The incidence of non neoplastic lesions are much more common in epididymis. Clinically, epididymal nodules are easily accessible to fine needle aspiration cytology (FNAC) procedure. There are very few literature reports documenting the role of cytology in evaluation of epididymal nodules. Thus, we studied patients presenting with palpable epididymis nodules in the out patient department (OPD) from a tertiary care general hospital.
Aim: This study is aimed to put forth the diagnostic utility of FNAC in palpable lesions of epididymis.
Materials and Methods: A total of 40 palpable epididymal nodules were aspirated as a routine OPD procedure as part of this study. Smears were fixed in isopropyl alcohol and air dried. In all the cases, wet fixed papanicoloau stained and air dried giemsa stained smears were studied. Zeihl Neelsen stain was performed in cases which yielded caseous aspirate.
Results: Except for two cases of adenomatoid tumor of epididymis all other lesions were nonneoplastic and included
14 cases (35%) of tuberculous granulomatous inflammation, 10 (25%) cystic nodules (9 spermatoceles and 1 encysted hydrocele), 5 (12.5%) of nonspecific inflammations, 3 (7.5%) filarial infection, 3 (7.5%) sperm granulomas and 3 (7.5%) adenomatous hyperplasia of rete testes. Except for the two tumors, one adenomatous hyperplasia and one tuberculous lesion, no other lesion was excised. Follow up and response to therapy was available in 78% patients and resolution indicated appropriateness of the diagnosis.
Conclusions: Thus, as most of the lesions in epididymis are non neoplastic responding to medical line of treatment and FNAC served to aid diagnosis of non specific inflammation and avoid surgical excision in most cases.
- Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period
Sumit Mitra, Suchandra Ray, Pradip K Mitra
Journal of Cytology 2011 28(3):108-110
Aims: This study was taken up with the aim to investigate the pattern of supraclavicular lymphadenopathy among patients presenting to our tertiary care institution, evaluate the diagnostic efficacy of fine needle aspiration cytology (FNAC), and analyze the diagnostic pitfalls.
Materials and Methods: A total of 215 patients were subjected to FNAC of supraclavicular lymph nodes over a three-year period (August 2006 to July 2009). Since in 18 patients as either the aspirate was inadequate or the opinion was equivocal, we analyzed the remaining 197 cases.
Results: Malignant pathology accounted for 79.7% (157/197) of the cases. These were mostly cases of metastatic squamous cell carcinoma (79/197, 40.1%), adenocarcinoma (47/197, 23.9%), small cell carcinoma (12/197, 6.1%) and lymphoma (10/197, 5%). There were 28 (14.2%) cases of tuberculosis. Out of these 197 patients, 92 patients were biopsied. The opinion based on FNAC was erroneous in 6 cases but corroborated with the final histopathology findings in the remaining 86 cases.
Conclusion: FNAC is an excellent first line of investigation; and when used with a proper combination of experience and diligence, it can greatly reduce the number of errors.
- The clinical effectiveness of fine needle aspiration biopsy in patients with palpable breast lesions seen at the University College Hospital, Ibadan, Nigeria: A 10-year retrospective study
Cornelius O Ukah, Olayiwola A Oluwasola
Journal of Cytology 2011 28(3):111-113
Background: Although open surgical biopsy is the 'gold standard' for diagnosis of palpable breast lesions, in recent years two types of minimally invasive breast biopsy techniques, core needle biopsy and fine needle aspiration biopsy (FNAB), have become established for the diagnostic evaluation of palpable breast lesions.
Aims: This study was undertaken to evaluate the clinical effectiveness of FNAB as a first line diagnostic procedure in the management of patients with breast lumps in University College Hospital (UCH), Ibadan, using the suggested thresholds for cytology performance as recommended by the United Kingdom National Health Services Breast Screening Programme (NHSBSP).
Settings and Design: A 10-year retrospective cohort study carried out in the Pathology Department of UCH.
Materials and Methods: All FNAB and histologically diagnosed cases of breast lesions in the pathology department between January 1996 and December 2005 were reviewed. The cytological diagnoses were then categorized into one of five diagnostic categories in accordance with the recommendations of the NHSBSP.
Results: The positive predictive value for malignancy was 99.3% with a complete sensitivity of 97.7% and specificity (full) of 94.2%.
Conclusions: The high quality assurance measures obtained in this study affirms FNAB as a clinically effective diagnostic procedure for breast lesions.
- Radio-pathological diagnosis of hepatobiliary ascariasis: A rare entity
Indranil Chakrabarti, Amita Giri, Anuradha De, Asit Chandra Roy
Journal of Cytology 2011 28(3):114-116
Ascariasis is the commonest helminthic infection in humans, caused by the nematode Ascaris lumbricoides. The adult worms usually reside in the small intestine. Rarely, they migrate into the bile duct and pancreatic ducts, but involvement of the gall bladder and/or liver parenchyma is extremely rare. Here, we describe a case of a 32-year-old woman who presented with fever, anorexia, right upper quadrant pain and mild hepatomegaly. Ultrasonography revealed a liver abscess and a concurrent moving adult worm in the gall bladder. Fine-needle aspiration cytology (FNAC) from the liver abscess showed presence of fertilized eggs of Ascaris lumbricoides. A diagnosis of gall bladder and hepatic ascariasis was made. The patient responded well to conservative management. Ascaris-induced liver abscess with concurrent living adult worm in gall bladder has rarely been reported. Ultrasonography and FNAC are important diagnostic modalities for detection of such lesions. Conservative management appears to be the treatment of choice for hepatobiliary ascariasis.
- The cytology of intracranial clear cell meningioma with an unusual scalp presentation
K Jayasree, KN Divya
Journal of Cytology 2011 28(3):117-120
Intracranial meningiomas are not often aspirated unless they erode the skull and present as swelling in the head and neck region. We describe the cytologic findings of fine needle aspiration cytology in a clear cell variant of intracranial meningioma presenting with swelling in the left parietal region of the scalp in a 45-year-old woman. The diagnosis was confirmed by histopathology. Clear cell meningioma is characterized by patternless sheets of clear polygonal cells. Clear cell meningioma is a rare distinctive cytological subtype of meningioma with high recurrence rate and increased mortality, which necessitate frequent follow-up after surgical excision. The recognition of clear cell meningiomas is important here and should be distinguished from other clear cell lesions of the scalp. If clear cell epithelial neoplasm is encountered on fine needle aspiration, it is reasonably possible to provide at least a differential diagnosis of meningioma based upon the focal whorls, sparce vascularity on low magnification, along with the presence of pseudoinclusion and inconspicuous nucleoli at high magnification.
- Fine needle aspiration cytology of metastatic alveolar rhabdomyosarcoma
Abhishek Sharma, Bhawna Bhutoria, Debasish Guha, Subodh Bhattacharya, Nazir Abdul Wasim
Journal of Cytology 2011 28(3):121-123
Rhabdomyosarcoma (RMS) is an aggressive malignant soft tissue tumor that arises from primitive striated muscle cells called rhabdomyoblasts. RMS is a rare tumor in adults, and involvement of the sinonasal area is extremely rare, comprising only 1.5% of all reported head and neck RMSs. Alveolar RMS, mainly seen in adults, has the worst prognosis. Incidence of lymph node metastases is more common in this type compared with the other forms. Fine needle aspiration cytology (FNAC) has been used extensively in the diagnosis of metastatic malignancies. However, metastatic soft tissue sarcomas are often overlooked, primarily due to the low frequency with which they occur. Here, we report a rare case of metastatic alveolar RMS in the cervical lymph nodes of an 18-year-old girl that was detected by FNAC. After 6 months, the patient came with a huge mass involving the nasal vestibule and the upper lip. Histology of both the main mass and the lymph nodes revealed alveolar RMS.
- The mystic thyroid nodule: A cytologist's confront
HR Vanisri, K Vani, CS Sheela Devi, R Sunila
Journal of Cytology 2011 28(3):124-126
Metastatic thyroid carcinoma is clinically silent and found only at autopsy in most instances. Renal cell carcinoma (RCC) is the most common and constitutes 56% of all secondary malignancies. However, preoperative distinction between primary and secondary thyroid neoplasms is often challenging. Fine needle aspiration is helpful in establishing a correct preoperative diagnosis. A local surgical resection is curative if prompt preoperative diagnosis is established. We hereby report a case of isolated metastatic RCC to the thyroid in a 65-year-old woman, diagnosed by fine needle aspiration cytology and later confirmed with histopathological examination.
- Fine needle aspiration cytology of a case of micropapillary variant of urothelial carcinoma of bladder
KN Divya, K Jayashree
Journal of Cytology 2011 28(3):127-130
Neoplastic urothelium has the capacity to demonstrate enormous plasticity. A variety of unusual morphological variants of urothelial carcinoma have been described. Micropapillary variant of urothelial carcinoma is a rare and recently described bladder tumor, associated with poor prognosis. We present the cytological features of micropapillary urothelial carcinoma in a 65-year-old man with bladder mass. The cytological features include tightly cohesive clusters of micropapillary component admixed with urothelial carcinoma. Histopathological sections showed small nests of tumor cells residing within the lacunae. Establishing a diagnosis of micropapillary urothelial carcinoma indicates a high-grade and high-stage tumor with poor outcome, requiring an aggressive therapy. It is thus important for the cytopathologist to recognise micropapillary variant of urothelial carcinoma, for early and better management of patients with bladder tumor.
- Extranodal manifestation of Rosai-Dorfman disease with bilateral ocular involvement
Chayanika Kala, Asha Agarwal, Sanjay Kala
Journal of Cytology 2011 28(3):131-133
Rosai-Dorfman disease, that is, sinus histiocytosis with massive lymphadenopathy is a benign systemic proliferative disorder of histiocytes. The typical clinical presentation of the disease includes bilateral painless massive lymphadenopathy, fever and polyclonal hypergammaglobulinemia. Extranodal involvement is present in only a few cases and skin lesions are the most common form of extranodal disease. However, purely cutaneous Rosai-Dorfman disease is uncommon. In this study, we describe a 10-year-old child presenting with bilateral ocular involvement.
- Cytological diagnosis of typical carcinoid on bronchoscopic brush smears in an HIV-positive patient
Neeta Kumar, Shahin Sayed, Swati Das
Journal of Cytology 2011 28(3):134-137
We report a case of typical carcinoid of the lung in a 60-year-old human immunodeficiency virus (HIV)-positive man diagnosed on brush cytology smears. Bronchial carcinoids are rare tumors, accounting for 1% to 2% of all lung tumors. Although the exact incidence in HIV-infected individuals is not known, the paucity of their documentation in the literature indicates that they may be equally rare. Cytological diagnosis on brush smears is rarely documented as the tumor is covered with mucosa and cellular yield is often not good. In this case, bronchial brushings showed distinctive cytological features of typical carcinoid. The awareness of its characteristic cytological features and differential diagnosis is required for an accurate diagnosis. Clinical awareness that non-acquired immunodeficiency syndrome (AIDS)-defining cancers can also occur in HIV-infected individuals in the context of the prolonged survival in the antiretroviral era is equally important. This case emphasizes the clinical importance of a broad differential diagnosis for lung lesions in HIV-positive patients.
- Coexistence of leukemic infiltration and extramedullary hematopoeisis in a lymph node: A cytological diagnosis
Niti Singhal, Anita Tahlan, Cherry Bansal, Uma Handa, Sanjay D'Cruz
Journal of Cytology 2011 28(3):138-140
Extramedullary hematopoeisis (EMH) occurs when function of the bone marrow is insufficient or destroyed. We report a case of lymph nodal mass in a young patient, diagnosed on fine needle aspiration cytology (FNAC) as infiltration by leukemia along with features of EMH. FNA smears from axillary lymph node revealed lymphoblasts with hand mirror cell and teat cell morphology. Also seen were occasional megakaryocytes and metamyelocytes.
- Cytodiagnosis and pitfalls of genital tuberculosis: A report of two cases
Ankit Seth, Madhur Kudesia, Kusum Gupta, Leela Pant, Anjali Mathur
Journal of Cytology 2011 28(3):141-143
Genital tuberculosis is fairly common in Indian women due to high prevalence of pulmonary tuberculosis in the general population. Histopathological diagnosis is invaluable but often, diagnosis can be made with reasonable accuracy by Papanicolaou (Pap) smear test if the index of suspicion is kept high. Also, genital tuberculosis is considered to be more common in patients less than 40 years of age and rare after menopause. We describe two cases of cervical tuberculosis in patients over 40 years of age, including a postmenopausal case, diagnosed by smear tests and later confirmed by histopathology and bacteriology. The differential diagnoses as well as problems encountered in the diagnosis of a tuberculous lesion in Pap smears are also discussed.
- Primary tuberculous parotitis
BN Gayathri, R Kalyani, K Manjula
Journal of Cytology 2011 28(3):144-145
- Cryptococcus in pleural fluid cytology in a patient with hepatitis B virus-associated chronic liver disease
Deepti Mutreja, Rakhi Malhotra, Uddipan Dutta
Journal of Cytology 2011 28(3):145-146
- Fine needle aspiration cytology in lesions of oral and maxillofacial region: Diagnostic pitfalls
Sunita Singh, Natasha Garg, Sumiti Gupta, Nisha Marwah, Rajneesh Kalra, Virender Singh, Rajeev Sen
Journal of Cytology 2011 28(3):93-97
Background: Fine needle aspiration cytology (FNAC) of oral and maxillofacial region has not been widely utilized for diagnosis due to diversity of lesion types, heterogeneity of cell populations and difficulties in reaching and aspirating these lesions.
Aim: Our aim was to demonstrate the effectiveness of this cheap and simple procedure for the diagnosis of tumor and tumor like lesions of oral and maxillofacial region. In addition, we sought to highlight probable causes of errors in the cases showing lack of correlation between cytological and histological diagnoses.
Materials and Methods: The study was conducted on 50 patients of all age groups with various palpable lesions in the oromaxillofacial region. A comparison between cytological and histological diagnosis was done wherever biopsy material was available.
Results: The rate of unsatisfactory FNA was 4%. There were six false negative cases but no false positive case. The sensitivity of our study ranged from 77.7 to 75% including and excluding the suspicious cases, respectively. Specificity and positive predictive value was 100%.
Conclusion: FNAC is a minimally invasive, highly accurate and cost-effective procedure for the assessment of patients with oromaxillofacial lesions. When applied in a proper manner, FNAC can help avoid a surgical biopsy in many cases.
- Morphology to morphometry in cytological evaluation of thyroid lesions
S Shanmuga Priya, Sandhya Sundaram
Journal of Cytology 2011 28(3):98-102
Aim: To evaluate the cytomorphometric features in fine needle aspiration cytology (FNAC) of thyroid lesions.
Materials and Methods: FNAC of 36 thyroid cases was reviewed. The study included 10 cases each of follicular lesion, adenomatous goiter, papillary carcinoma, 4 cases of medullary carcinoma and 2 cases of anaplastic carcinoma. Their ages ranged from 28 to 50 years, and there were nine females and one male. Morphometric analysis was done on aspiration smears from 36 thyroid lesions. Hematoxylin and Eosin stained smears were examined using image analyzer Proplus V software. Morphological parameters measured included mean nuclear diameter, mean nuclear perimeter, mean nuclear area, circular rate, largest to smallest dimension ratio (LS ratio) and coefficient of variation of nuclear area (NACV).
Statistical Analysis: Statistical evaluation was carried out using the analysis of variance (ANOVA) test for the five variables, both within the group and in between the groups. The result was considered significant when P < 0.05.
Results: The follicular carcinomas had higher LS ratio than patients with adenomatous goiters. Mean nuclear diameter and the mean nuclear perimeter were higher in anaplastic carcinomas when compared to other subtypes and were the least for follicular neoplasms.
Conclusion: When correctly applied, quantitative estimation of cytological nuclear features can play an important role in preoperative assessment and can complement morphological features in thyroid lesions.
VOL 30 NUMBER 1 (2013)
- The integration of HR-HPV increases the expression of cyclins A and E in cytologies with and without low-grade lesions
MI Zubillaga-Guerrero, B Illades-Aguiar, MA Leyva-Vazquez, E Flores-Alfaro, E Castañeda-Saucedo, JF Muñoz-Valle, LC Alarcón-Romero
Journal of Cytology 2013 30(1):1-7
Background: Cyclin-A and cyclin-E are regulators of G1-S phase of normal cell cycle. Integration of human papilloma virus high-risk (HR-HPV) could alter this mechanism, and its overexpression has been associated with poor prognosis in cervical cancer.
Aim: To determine the expression of cyclin-A and cyclin-E, types of HR-HPV and physical state of DNA in cytologies with the diagnosis of low-grade squamous intraepithelial lesion (LSIL).
Materials and Methods: 115 cytological specimens in liquid base (liquid-PREP™ ) were analyzed. 25 specimens were with no signs of SIL (NSIL) and without HPV; 30 with NSIL with low-risk HPV (LR-HPV); 30 with NSIL with HR-HPV; and 30 with both LSIL and HR-HPV. The expression of cyclins was evaluated by immunocytochemistry; and the detection of viral DNA was done by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLPs) for genotyping or sequencing of HPV. The physical state of HPV was evaluated by in situ hybridization with amplification with tyramide.
Results: In the cytologies NSIL with LR-HPV, the expression of cyclin-A and cyclin-E was found respectively in 23.3% and 33.3% of the specimens. Among the specimens of NSIL with HR-HPV, 33.3% expressed cyclin-A and 40% cyclin-E, while 100% of the LSILs expressed the 2 cyclins. On the other hand, 100% of the samples NSIL with LR-HPV presented an episomal pattern. Of the specimens of NSIL with HR-HPV, 56.6% exhibited an episomal pattern, 23.3% integrated and 20%, mixed. Among the LSILs, 90% were mixed and 10% integrated.
Conclusions: The cyclins A and E are present in the LSILs that occur predominantly in mixed state in the presence of HR-HPV.
- Comparative study of intra-operative cytology, frozen sections, and histology of tumor and tumor-like lesions of nose and paranasal sinuses
JS Nigam, V Misra, V Dhingra, S Jain, K Varma, A Singh
Journal of Cytology 2013 30(1):13-17
Background: The nasal cavity and paranasal sinuses - including the maxillary, ethmoid, sphenoid, and frontal sinuses are collectively referred to as the sinonasal tract. Fine needle aspiration (FNA) of paranasal sinus lesions for early diagnosis of neoplastic lesions is difficult due to closed architecture, and only one study has been documented in the literature.
Aims: To find the efficacy of intra-operative cytology and frozen section for frequently encountered tumor and tumor-like lesions of the nose and paranasal sinuses.
Materials and Methods: Thirty cases were included in this study. The material for cytologic examination and frozen sections were taken per-operatively. Cytological smears were prepared by imprint/squash methods from the representative tissue pieces and stained with Leishman-Giemsa and Papanicolaou. Frozen section and paraffin-embedded section were stained with hematoxylin and eosin stain. A rapid opinion regarding the benign or malignant nature of the lesion and the type of tumor was given.
Results: The sensitivity, specificity, and positive predictive value of imprint cytology, squash cytology, and frozen section were 100%, 100%, and 100%; 100%, 96.15%, and 80.0%; and 100%, 96.15%, and 80.0%, respectively. Overall diagnostic accuracy of imprint smears, squash smears, and frozen section was100%, 96.7%, and 96.7%, respectively. Imprint smears had better specificity as cells morphology could be more accurately appreciated.
Conclusions: Intra-operative cytology and frozen section examinations of lesions of nose and paranasal sinuses are useful, quick, and reliable diagnostic technique for rapid diagnosis in the operation theatre and can be used as an adjunct to histopathology for better management of patients.
- Leishman Giemsa cocktail as a new, potentially useful cytological technique comparable to Papanicolaou staining for oral cancer diagnosis
UI Belgaumi, P Shetty
Journal of Cytology 2013 30(1):18-22
Background: Papanicolaou staining is commonly used for staining exfoliative cytology smears with Romanowsky stains being used sparingly. Leishman Giemsa (LG) cocktail, being a relatively new staining technique, has not been used in exfoliative cytology. This easy, cost-effective and one-step technique warrants further study because of its potential application in screening of oral cancer.
Aim: To study and evaluate the diagnostic efficiency and reliability of Leishman Giemsa (LG) cocktail in comparison with Papanicolaou (Pap) and May-Grόnwald Giemsa (MGG) stains in exfoliated cells for the detection of oral squamous cell carcinoma.
Materials and Methods: Three smears were prepared from each 100 controls (buccal mucosa) and 100 patients, clinically diagnosed with oral squamous cell carcinoma and stained with Pap, MGG and LG cocktail stains. The slides were evaluated for the staining characteristics of nucleus and cytoplasm. The diagnostic efficiency of each stain was evaluated by comparing the cytologic diagnosis of each stain with the histopathological diagnosis. Finally, the diagnostic reliability was evaluated by comparing the three stains with each other and the histologic diagnosis.
Statistical Analysis: The data were statistically evaluated with Friedman test, Wilcoxon sign rank test and McNemar chi square test using SPSS15 software.
Results: The results from the histologically confirmed cases of squamous cell carcinoma and the number of cases diagnosed by Pap and LG cocktail were almost identical and both were superior to MGG. The P value obtained for the confirmed cases of squamous cell carcinoma in comparison for Pap vs MGG was 0.001, MGG vs LG cocktail was 0.001 and LG cocktail vs Pap was 0.157. Hence, no statistical significant difference was observed between the diagnostic ability of Pap and LG cocktail stains.
Conclusion: LG cocktail is an easy, cost-effective and one-step technique comparable to Pap staining; however, it warrants further study in its potential application in screening of oral cancer.
- Insight to neoplastic thyroid lesions by fine needle aspiration cytology
M Rangaswamy, KL Narendra, S Patel, C Gururajprasad, GV Manjunath
Journal of Cytology 2013 30(1):23-26
Background: Fine needle aspiration cytology (FNAC) is a valuable adjunct to pre-operative screening in the diagnosis of thyroid nodules, and in most cases, it can distinguish between benign and malignant lesions.
Aim: To study the cytology of neoplastic thyroid lesions to minimize surgical intervention and for confirmation of the diagnosis by histopathological study.
Materials and Methods: 100 cases of thyroid FNAC smears were analyzed and cyto-histopathological correlation was done in 47 cases. Galen and Gambino's method was used to calculate the sensitivity and positive predictive value.
Results: Of the 100 cases, 90 were diagnosed as neoplastic lesions by FNAC and ten cases as non-neoplastic lesions, which turned out to be neoplasms on histopathological study. Among 100 cases, 47 were biopsied and subjected to histopathological study. The sensitivity of FNAC was 75.60%, and positive predictive value was 83.78% for malignant lesions.
Conclusions: FNAC is a rapid, efficient, cost-effective, relatively painless procedure with a high diagnostic accuracy. It has high rate of sensitivity and positive predictive value in diagnosing thyroid neoplastic lesions. Hence, it is a valuable tool in the diagnosis and management of patients.
- Clinico-radiological and pathological evaluation of extra testicular scrotal lesions
Suparna Mukherjee, Veena Maheshwari, Roobina Khan, Syed Amjad Ali Rizvi, Kiran Alam, Syed Hasan Harris, Rajeev Sharma
Journal of Cytology 2013 30(1):27-32
Background: Scrotal ultrasound, though reliable in distinguishing between intratesticular and extratesticular lesions and characterizing them as cystic and solid, cannot distinguish benign from malignant pathology. Although fine needle aspiration cytology (FNAC) has proved to be of great diagnostic importance in testicular lesions, its scope in extratesticular lesions is largely unexplored.
Aim: To evaluate extratesticular scrotal lesions cytologically and compare it with their clinical, radiological, and histological findings.
Materials and Methods: Sixty five patients with extratesticular scrotal lesions were assessed clinically, radiologically, and cytologically. Histopathology was done in 45 cases where surgical exploration was undertaken. All the data were then analyzed and correlated.
Results : Extratesticular lesions accounted for 72.2% of the scrotal swellings. Of these, the epididymis is most commonly involved (61.5% cases) with the commonest type of lesion being cystic (49.3% cases). Ultrasonography preferably with color doppler is highly useful for the evaluation of the scrotum. Apart from distinguishing extratesticular from testicular and cystic from solid lesions, it has an important role in identifying individual lesions, thus reducing the list of differential diagnosis. Fine needle aspiration cytology contributed to a definitive diagnosis in 47.7% cases. It helps classify cystic masses on the basis of their contents and defines the etiology of chronic inflammatory lesions, apart from corroborating with the clinico-radiological diagnosis. Histological evaluation was possible only in cases where surgery was performed and helps further define the diagnosis.
Conclusion : Fine needle aspiration cytology is essentially non-traumatic and easy to carry out and should be a technique of choice for the study of scrotal pathology, main advantage being avoidance of delays in diagnosis.
- Evaluation of the category high-grade squamous intraepithelial lesion in The Bethesda System for reporting cervical cytology
Subhalakshmi Mukhopadhyay, Sumit Ray, Supria Dhar, Ranjana Bandyopadhyay, Swapan K Sinha
Journal of Cytology 2013 30(1):33-35
Background: High grade squamous intraepithelial lesion (HSIL) is a category of The Bethesda System (TBS) for reporting cervical cytology that is in vogue since the introduction of the said system in 1988 and it was not modified in 2001 modification of TBS. The term includes moderate dysplasia (CIN II), severe dysplasia (CIN III) and squamous cell carcinoma in situ. Terms like ASC-US used in TBS are being considered to be not very useful in the prediction about the possible behavior of the pathological status of the cervix. After more than 10 years of use the term HSIL also needs fresh evaluation as in this category two entities of potentially different outcome are clubbed.
Aims: The aim was to find out whether it is justified to have a term like HSIL which includes different points of the spectrum of intraepithelial pathology of cervix from moderate hyperplasia through carcinoma in situ, all having different significance.
Materials and Methods: In this study 619 cases of cervical cytology reported by TBS were evaluated by comparing them with biopsy reports of the same lesion for the assessment of the sensitivity, specificity and positive predictive value of HSIL as a category of diagnosis in TBS.
Results: As a category, HSIL had the diagnostic sensitivity of 96.4%, specificity of 87.5%. The positive predictive value was 96.4%.
Conclusion: HSIL as a diagnostic category shows a very good predictive accuracy, which implies that it provides a very high probability of the accurate diagnosis collectively of all the conditions in the disease spectrum from moderate dysplasia through in situ carcinoma. Hence, HSIL was found to be a very useful diagnostic category in TBS that conveys proper message to the clinician.
- Image-guided fine-needle aspiration of retroperitoneal masses: The role of the cytopathologist
Ghazala Mehdi, Veena Maheshwari, Sheerin Afzal, Hena A Ansari, Ibne Ahmad
Journal of Cytology 2013 30(1):36-41
Background : Retroperitoneal tumors constitute a difficult diagnostic category as they are not easily accessible. The advent of image-guided fine-needle aspiration (FNA) has resolved this problem significantly.
Aims : We present a short study based on guided aspiration of retroperitoneal tumors, in which we have tried to assess the role of image-guided fine-needle aspiration cytology as a tool for pre-operative diagnosis.
Materials and Methods : The study was conducted on patients diagnosed with retroperitoneal masses. FNA was performed under image guidance with the help of ultrasonography and/or computed tomography; smears were prepared and meticulously screened according to a fixed protocol. The results were analyzed to determine sensitivity, specificity, and diagnostic efficacy of cytopathological diagnosis using image-guided FNA techniques.
Results: We assessed 38 patients with retroperitoneal masses. In all cases, adequate cellular material was obtained. No major complications were encountered. Statistical analysis was carried out in 35 cases; sensitivity, specificity, and diagnostic accuracy were 100% in these cases.
Conclusion: FNA under image guidance should be considered a first-line diagnostic approach for retroperitoneal and other abdominal tumors, although caution should be exercised in case selection. In areas where advanced tests are not available, the cytotechnologist and cytopathologist have a very important role to play in ensuring accurate diagnoses.
- Intravascular papillary endothelial hyperplasia diagnosed by fine needle aspiration: Report of a case and cytology literature review
A Kovalovsky, A Reynders, KK Khurana
Journal of Cytology 2013 30(1):42-45
Intravascular papillary endothelial hyperplasia (IVPEH) is an unusual form of intravascular endothelial proliferation. Fine needle aspiration (FNA) diagnosis of IVPEH is quite challenging and only rare reports of the cytopathological features of this entity have been published. We report a case of a 55-year-old female patient who presented with a mass on her left jaw. FNA of the mass revealed pleomorphic polygonal and spindle cells. A preliminary (onsite) cytological diagnosis of suspicious for malignancy was rendered. Subsequent cell block showed delicate papillae composed of attenuated endothelial cells overlying collagenized cores. The endothelial cells were positive for CD34 and factor VIII, supporting the cytological diagnosis of IVPEH. Surgical excision confirmed the diagnosis. To the best of our knowledge, this is the first reported case of IVPEH diagnosed by preoperative FNA.
- A case of pancreatic ductal adenocarcinoma with marked infiltration with IgG4-positive cells
M Yoneda, H Inada, K Kanayama, T Shiraishi
Journal of Cytology 2013 30(1):46-48
A 75-year-old man was diagnosed as having pancreatic ductal carcinoma containing remarkable lymphocytic and plasma cell infiltration, as revealed by the cytological examination of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA) specimen. The EUS-FNA specimen showed small amounts of atypical epithelium with noticeable lymphocytes and plasma cells. A pancreatic resection was performed, and the histopathological features showed an invasive pancreatic ductal carcinoma with autoimmune pancreatitis (AIP) lymphoplasmacytic sclerosing pancreatitis (LPSP)-like lesions. Most of the plasma cells were immunoreactive to anti-IgG4 antibody. EUS-FNA may be necessary for the differential diagnosis of AIP and pancreatic cancer, and close attention should be given to the presence of marked lymphoplasmacytic cells in EUS-FNA specimens while making the diagnosis.
- Nodular sclerosing adenosis of breast: A diagnostic pitfall in fine needle aspiration cytology
S Sreedharanunni, A Das, S Veenu, R Srinivasan, G Singh
Journal of Cytology 2013 30(1):49-51
Fine needle aspiration cytology was performed in a 46-year-old female presenting with a breast lump and mammography suggesting a malignancy. The smears were cellular with cohesive clusters and scattered epithelial cells showing moderate nuclear pleomorphism and focal acinar formation. Stromal fragments, benign epithelial cell clusters and a few naked nuclei were noted in the background. Considering the clinical features, mammography findings as well as cytological features, a diagnosis of ductal carcinoma was suggested. Subsequent histopathological examination revealed it to be nodular sclerosing adenosis. The cytohistological correlation of this uncommon lesion, a potential pitfall in breast fine needle aspiration diagnosis which may lead to a false-positive diagnosis is discussed.
- Anorectal smear in the diagnosis of anorectal adenocarcinoma
D Demirel, I Ramzy
Journal of Cytology 2013 30(1):52-54
The purpose of this case report is to point out the diagnostic value of cytologic smears in patients presenting with anorectal complaints, such as bleeding, pain or discomfort, which may suggest a neoplastic lesion. We present a case of a 64-year-old man with a 3 months' history of anal bleeding and pain during defecation. He was diagnosed as having hemorrhoids and a hemorrhoidectomy was performed. The patient developed an anal stricture postoperatively that required operative dilation. He continued to complain about anorectal pain for 2 months and a subsequent rectoscopy revealed the presence of tumor 5 to 7 cm above the dentate line. The tumor was resected laparoscopically and was reported as an adenocarcinoma. Rectal bleeding recurred 18 months postoperatively and a smear was procured from the anorectal mucosal surface for cytologic evaluation. A definitive diagnosis of adenocarcinoma was rendered based on cytologic and histologic examination of the material. To the best of our knowledge, this is the first case report of anorectal adenocarcinoma diagnosed by cytologic smear in the English literature.
- Spindle cell lipoma masquerading as lipomatous pleomorphic adenoma: A diagnostic dilemma on fine needle aspiration cytology
S Agarwal, A Nangia, P Lalita Jyotsna, M Pujani
Journal of Cytology 2013 30(1):55-57
Spindle cell lipoma is a relatively uncommon benign adipocytic tumor that usually presents in subcutaneous fat of adult men. These are a rare form of lipoma, accounting for 1.5% of all lipomatous tumors, with a low rate of local recurrence and no risk of malignant behavior/dedifferentiation. Although few studies addressing the histological findings of spindle cell lipoma have been described, only a few descriptions of fine needle aspiration cytology (FNAC) findings have been documented in literature. We present a case of a 55-year-old male with a nodular swelling over left cheek (in the parotid region), which due to its location as well as prominent myxoid background prompted us to include the lipomatous salivary gland lesions in differential diagnosis. Our objective is to document and delineate the characteristic cytological features of spindle cell lipoma, which may permit a confident diagnosis on FNAC smears.
- Cytodiagnosis of alveolar soft part sarcoma: Report of two cases with special emphasis on the first orbital lesion diagnosed by aspiration cytology
K Majumdar, RK Saran, I Tyagi, AK Jain, A Jagetia, S Sinha, A Singh
Journal of Cytology 2013 30(1):58-61
Alveolar soft part sarcoma (ASPS) is a rare neoplasm of uncertain cell of origin. Known to occur in adolescents and young adults, this tumor usually involves the muscles and deep soft tissues of the extremities and trunk. Orbital localization is rare and not yet subjected to cytological assessment, as per our literature search. We present here two cases of ASPS diagnosed by aspiration cytology, one in the orbit and the other in the lower extremity. The cells displayed abundant clear to finely vacuolated cytoplasm, often with disrupted margins and flowing of the cytoplasmic material; prominent nucleoli and scattered bare nuclei were also seen in the background. Two close cytological differential diagnoses include metastatic renal cell carcinoma and paraganglioma. Intracytoplasmic periodic acid schiff (PAS) positive, diastase-resistant, needle-shaped crystals and corresponding rhomboid crystals with regular lattice pattern on ultrastructure are the hallmarks of this neoplasm. Due to its slowly progressive clinical course and poor outcome, preoperative diagnosis of ASPS through fine-needle aspiration cytology may be essential for deciding therapy, especially in rare and difficult locations like orbit, where adjuvant radiation may not be possible.
- Benign breast myoepithelioma
L Khan, S Srivastava, PK Singh, M Ather
Journal of Cytology 2013 30(1):62-64
Myoepithelioma of the breast is very rare. Breast myoepithelioma can develop in women from their early 20s right up to their 80s, but it is most common in women over 50. We report a case of 20-year-old female, who presented with a well-defined breast lump of 3 × 3 cm in size. Fine needle aspiration was performed. The cytological findings revealed good cellularity comprising monomorphic loosely cohesive sheets of plasmacytoid, round to polygonal cells with round to ovoid eccentrically placed nuclei, finely dispersed chromatin, and moderate amount of cytoplasm. On the basis of cytological findings, a diagnosis of benign myoepithelioma (plasmacytoid type) was made which was confirmed on histopathologic examination. The breast is a very rare localization for this type of tumor. The benign character of the disease in conjunction with its slow progression could delay its detection and diagnosis. A detailed pathology examination is a prerequisite for avoidance of misleading diagnosis.
- Adenomatoid tumor of testis: A rare cytological diagnosis
M Makkar, P Dayal, C Gupta, NC Mahajan
Journal of Cytology 2013 30(1):65-67
Adenomatoid tumor is a benign neoplasm of the male and female genital tracts arising from mesothelial cells. Fine needle aspiration cytology (FNAC) plays a pivotal role in its preoperative diagnosis. Therefore, it is imperative that pathologists should be well aware of its cytological features so as to avoid erroneous diagnosis and hence prevent unnecessary surgical interventions. We hereby, present a case of adenomatoid tumor of testis in a 41 year male diagnosed by FNAC and later confirmed by histopathological examination.
- Pigmented Paget's disease of nipple: A diagnostic challenge on cytology
BR Vani, MU Thejaswini, V Srinivasamurthy, M Sudha Rao
Journal of Cytology 2013 30(1):68-70
Paget's disease is a rare form of breast cancer often associated with an underlying ductal carcinoma in situ or invasive cancer. A 47-year-old female patient presented with bleeding from the left nipple since 4 months. Imprint smears from the lesion showed pleomorphic malignant epithelial cells in singles and in small clusters, many of them containing dark brown cytoplasmic pigment granules. There was no palpable breast lump or axillary lymph node enlargement. Based on the physical examination and cytological features, a diagnosis of malignant melanoma with a differential of Paget's disease of the nipple was made. Biopsy showed features of Paget's disease and immunohistochemistry was positive for HER-2/neu, negative for HMB-45 and S-100, thus confirming the diagnosis. This case has been reported to emphasize the fact that Paget's cells can contain imbibed brown cytoplasmic pigment and should not be mistaken for melanoma cells on cytology smears.
- Cytomorphology of pleomorphic fibroma of skin: A diagnostic enigma
YK Yadav, R Kushwaha, U Sharma, K Gupta
Journal of Cytology 2013 30(1):71-73
Pleomorphic fibroma (PF) is a benign, polypoid, or dome-shaped cutaneous neoplasm with cytologically atypical fibrohistiocytic cells. We describe the cytomorphological features of PF retrospectively with histopathological diagnosis in a 38-year-old male who presented with 3 × 1.5 cm swelling in the soft tissues of the thigh for 6 months. This lesion is benign despite the presence of pleomorphic or bizarre cells. We review the differential diagnosis of PF with other mesenchymal tumors. To the best of our knowledge, cytomorphological features on fine needle aspiration cytology of this tumor are not yet documented in literature.
- Peritoneal washing cytology in an adult granulosa cell tumor: A case report and review of literature
Alev O Atilgan, Merih Tepeoglu, Ozlem Ozen, Banu Bilezikçi
Journal of Cytology 2013 30(1):74-77
Adult-type granulosa cell tumors (AGCT) account for 1-2% of all ovarian tumors and 95% of granulosa cell tumors. In AGCT, at the time of peritoneal washing, tumor cells are rarely seen to exfoliate and FIGO stage is raised from IA/IB or IIA/IIB to stage IC or IIC despite the absence of a gross intraepithelial tumor. Patients with positive peritoneal washing cytology must be followed up for pelvic recurrence and metastasis. A more sensitive cytologic evaluation, histopathologic correlation and immunohistochemical staining can advance our practice. Here, we describe a case of AGCT with the emphasis on cytologic features observed in specimens obtained from peritoneal washing fluid.
- Role of cytology in fibroadenoma with clinging carcinoma
N Swetha, CH Geetha, Aruna K Prayaga
Journal of Cytology 2013 30(1):78-80
Fibroadenoma is the most common benign breast tumor in adolescent girls and young women with a peak incidence in the second and third decades of life. Carcinoma arising within a fibroadenoma is rare and is usually discovered incidentally. We describe a case of clinging type of ductal carcinoma in situ (DCIS) arising within a fibroadenoma. Clinging carcinoma, a variant of DCIS is an under recognized entity. Diagnosis of DCIS is made based on architecture and cytology. This case report highlights the role of fine needle aspiration cytology in the diagnosis of this entity coexisting in a fibroadenoma.
- Cytomorphology of gastrointestinal stromal tumors and extra-gastrointestinal stromal tumors: A comprehensive morphologic study
M Vij, V Agrawal, A Kumar, R Pandey
Journal of Cytology 2013 30(1):8-12
Background: The term gastrointestinal stromal tumors (GIST) is used to refer to those mesenchymal neoplasms of the gastrointestinal tract (GIT) which express CD117, a c-kit proto-oncogene protein.
Aims: To study the cytological features of GIST and extra-gastrointestinal stromal tumors (EGIST), to correlate them with histology and to determine cytological indicators of malignancy.
Materials and Methods: Cytological smears from patients diagnosed as GIST/EGIST on histology were retrieved. From Jan 2000 to July 2010, 26 GIST (13 primary, 12 metastatic, one recurrent) and seven EGIST (5 primary, one metastatic, one recurrent) cytologic samples from 27 patients were identified.
Results: The patients included 20 males and 7 females with a mean age of 50.6 years. Tumor sites included stomach (5), duodenum (5), ileum (2), ileocecal (1), rectum (1), liver (9), retroperitoneum (5), mesentery (1), subcutaneous nodule (1), supra-penile lump (1), ascitic (1) and pleural fluids (1). The smears were cellular with cohesive to loosely cohesive thinly spread irregularly outlined cell clusters held together by thin calibre vessels. The tumor cells were mild to moderately pleomorphic, spindle to epithelioid with variable chromatin pattern and variable cytoplasm. Cellular dyscohesion, nuclear pleomorphism, intranuclear pseudoinclusions, prominent nucleoli, mitosis and necrosis were more prominent in malignant, metastatic and recurrent tumors.
Conclusions: GISTs show a wide spectrum of cytological features and the presence of mitosis, necrosis and nuclear pleomorphism can help in prediction of malignant behavior. Further, cytology is a very useful screening modality in patients of GIST and EGIST to detect early recurrence and metastasis at follow-up.
- Cytological diagnosis of Langerhans cell histiocytosis with cutaneous involvement
Sushama A Chandekar, Vinaya B Shah, Vikas Kavishwar
Journal of Cytology 2013 30(1):81-83
Langerhans cell histiocytosis (LCH) is a rare disease affecting predominantly children. The course of the disease varies, from spontaneous resolution to a progressive multisystem disorder with organ dysfunction and potential life-threatening complications. Diagnosis of LCH is often difficult and may be delayed because of its rarity and especially so if it occurs with unusual presentation. Fine needle aspiration cytology of a 4 year old male child, a case of LCH is presented with a purpose of highlighting the characteristic cytological features. A high index of suspicion, awareness of characteristic cytological features of LCH and its differential diagnoses is necessary. This can obviate the need of biopsy and electron microscopy. Immunohistochemistry if available can be performed on cytology smear and cell block.
- Cytological diagnosis of primary cardiac diffuse large B cell lymphoma
Slim Charfi, Raoudha Charfi, Hela Mnif, Tahya Sellam- Boudawara
Journal of Cytology 2013 30(1):84-85
- A simple working type classification proposed for the spindle cell neoplasms of the oral cavity
Journal of Cytology 2013 30(1):85-85