ISSN: 0970-9371 eISSN: 0974-5165 |
Published by Medknow Publishers
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.
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
VOL 30 NUMBER 2 (2013)
- Frequency and patterns of abnormal Pap smears in Sudanese women with infertility: What are the perspectives?
Ahmed O Almobarak, Mohammed H Elhoweris, Hilmi M Nour, Mohammed Abd Allah M Ahmed, Al-Fadhil Alobeed Omer, Mohamed H Ahmed
Journal of Cytology 2013 30(2):100-103
Background: Pelvic inflammatory disease is one of the major causes of infertility in females. Also, women with infertility are at high-risk of developing cervical intraepithelial lesions or even carcinoma.
Aim: To assess the prevalence and patterns of epithelial cell abnormalities in cervical smears in Sudanese infertile and fertile women.
Materials and Methods: The present study included 200 cases (women with infertility) of age group 20-60 years who had routine pap smear. A total of 700 fertile women constituted the control group.
Results: Among the 200 infertile women, 93.5% reported as negative for intraepithelial lesion or malignancy (NILM), and 6.5% were epithelial cell abnormalities (atypical squamous cells of undetermined significance and above). In the control group 96.6% of the smears reported as NILM and 3.4% as epithelial cell abnormalities. The percentage of abnormal pap smears in the infertile women was significantly higher when compared with the control group.
Conclusions: Epithelial cell abnormalities are significantly higher in women with infertility as compared with fertile women. Importantly, inflammatory smears were reported two times more than in the controls. We recommend pap smear as a routine practice for all women assessed for infertility problems. Further studies are necessary to evaluate the incidence of human papilloma virus infections in infertile women with abnormal cervical cytology.
- Cytomorphometric and cytomorphologic analysis of oral mucosa in children with sickle cell anemia
Juliana Umetsu Paraizo, Itauana Aliete Vettorello Rech, Luciana Reis Azevedo-Alanis, Mara Albonei Dudeque Pianovski, Antonio Adilson Soares De Lima, Maria Ângela Naval Machado
Journal of Cytology 2013 30(2):104-108
Background: Sickle cell anemia (SCA) is an autosomal recessive genetic disorder, characterized by chronic hemolytic anemia, episodic painful crises, and pathologic involvement of many organs, consequence of vaso occlusive phenomenon and vasculopathy. Several forms of the chronic anemia, consequence of hemolysis, can be associated with oral epithelial cells changes. Exfoliative cytology can be used to detect real changes in the oral mucosa in SCA.
Aims: To evaluate morphometric and morphological changes in oral epithelial cells by exfoliative cytology in children with SCA.
Materials and Methods: Oral smears were collected from clinically normal-appearing mucosa by liquid-based exfoliative cytology in 20 SCA children (SCA group) and 20 healthy children (C group), matched for age and gender. The slides were prepared and stained by the Papanicolaou technique. Cell morphology and cellularity were analyzed and compared by Chi-square test (P < 0.05). Images of 50 cells per slide were captured and the nuclear area (NA) and cytoplasmic area (CA) were analyzed using an image analysis system. The nucleus-to-cytoplasmic area ratio (NA/CA) was calculated. To compare the means of groups SCA and C, the Student's t-test (P < 0.05) was applied to NA and CA; test non-parametric Mann Whitney U (P < 0.05) was used to compare NA/CA.
Results: Mean values for SCA and C groups were: NA (69.38 and 59.63 μm²; P = 0.01); CA (2321.85 and 2185.60 μm²; P = 0.24); NA/CA (0.03 and 0.02; P = 0.13), respectively. A significant increase in NA for SCA group (P = 0.01) was seen. No morphological differences were found between the groups. There was a predominance of nucleated cells of the superficial layer in the smears of both groups. Class I smears were predominant in both groups.
Conclusions: This study revealed that SCA was able to induce significant changes on nuclear area of the oral epithelial cells.
- Cytomorphometric analysis of the gingival epithelium in type 2 diabetic patients with and without smoking habit
Punit Vaibhav Patel, Sheela Kumar Gujjari
Journal of Cytology 2013 30(2):109-115
Background: It has been shown that cigarette smoking as well as diabetes mellitus can produce cytomorphometric alterations in oral epithelial cells with the significant increase in the nuclear area (NA) and significant decrease in the cytoplasmic/nuclear ratio in comparison to healthy control. However, the synergistic effect of tobacco smoking and diabetes on the morphology of gingival epithelial cells is not been explored until date.
Aim: This study was carried out to investigate the effects of diabetes and the synergistic effects of smoking and diabetes on the cytomorphometry of gingival epithelium.
Materials and Methods: Gingival smears were collected from 30 male subjects diagnosed with type 2 diabetes with
(n = 10) or without history of smoking habit (n = 10). Healthy subjects with no history of smoking or diabetes served as the control group (n = 10). The smears were stained using Papanicolaou procedure. The cellular (CA) and nuclear areas (NA) were measured using image analysis software. One-way ANOVA and Tukey-HSD procedure (at P = 0.05) were used to analyze all the parametric variables.
Results: A statistically significant (P < 0.001) increase in NA and N:C ratio in smoker diabetic group was observed compared to the non-smoker diabetic group and the control group. The non-smoker diabetic group also showed significant increase
(P < 0.001) in NA and N:C ratio when compared to the control group, whereas the comparison of the three groups for difference in CA was not statistically significant at P > 0.05.
Conclusions: There were significant alterations in the cellular pattern of gingival mucosa cells in a non-smoker diabetic, but the alteration was to a greater extent in smoker diabetics demonstrating a synergistic effect of smoking and diabetes on gingival mucosa.
- Cytomorphological variables of hepatic malignancies in fine needle aspiration smears with special reference to grading of hepatocellular carcinoma
Sharda Balani, Reeni Malik, Rajesh Malik, Neelkamal Kapoor
Journal of Cytology 2013 30(2):116-120
Background: The evaluation and management of discrete hepatic masses is a clinical problem. Ultrasound guided fine needle aspiration cytology (FNAC) is a rapid, accurate and safe diagnostic procedure that can be used in various neoplastic and non-neoplastic diseases of the liver.
Aim: To evaluate the cytomorphological features of hepatocellular carcinoma.
Materials and Methods: Ultrasound-guided fine needle aspiration was performed on 52 patients clinically suspected of having hepatic lesion.
Results: Malignancy was detected in 50 cases. The primary malignancies consisted of 15 cases of hepatocellular carcinoma (HCC), 4 cases of cholangiocarcinoma and 2 of hepatoblastoma. There were 29 metastatic lesions, which included 26 cases of adenocarcinoma, 2 cases of squamous cell carcinoma and 1 of lymphoma. The key diagnostic features for HCC were trabecular arrangement, polygonal cells with eosinophilic and granular cytoplasm, hyperchromatic nuclei with macronucleoli. Atypical naked hepatocytic nuclei and malignant cells separated by sinusoidal capillaries were also commonly seen. The sensitivity and specificity of FNA for malignancies was found to be 96% and 100% respectively, yielding a positive predictive value of 100% and negative predictive value of 50%.
Conclusions: There was a very good correlation of cytological criteria and histopathological diagnosis in hepatocellular carcinoma of various grades as well as in differentiating primary from metastatic tumors. It is recommended that image directed FNAC should be the primary diagnostic modality for assessing potential malignancy in any patient with a localized hepatic mass.
- Immunocytochemistry: It's role in diagnosis of undifferentiated neoplasms by fine needle aspiration cytology
Palash Kumar Mandal, Santosh Kumar Mondal, Shravasti Roy, Anindya Adhikari, Nandita Basu, Swapan Kumar Sinha
Journal of Cytology 2013 30(2):121-124
Background: Fine needle aspiration cytology (FNAC) is a rapid, cheap and reliable method for diagnosing any accessible lesion. However, there remains a group of malignant undifferentiated neoplasms, which can only be categorized with the help of immunocytochemistry (ICC). The categorization is important due to their vast difference in treatment and prognosis.
Aim: To evaluate the effectiveness of ICC in categorizing the undifferentiated neoplasms diagnosed on routine FNAC smears.
Materials and Methods: Thirty six cases of undifferentiated neoplasms were selected from a group of total 78 cytology cases of undifferentiated tumors from different sites like head and neck, lymph node, soft tissue etc. These were then subjected to a panel of ICC markers based on the clinical and cytomorphological features.
Results: Of these, 21 were simple, ten were computerized tomography guided and five were ultrasound guided FNACs respectively. All the 78 cases were confirmed by histopathological examination and immunohistochemistry. Of the 36 cytological cases, final diagnosis correlated in 30 cases histologically. The six cases were incorrect either due to inadequate material on the smears (three cases) or false positive staining (three cases).
Conclusions: Our study found that ICC is a sensitive and specific method for early and definitive diagnosis of undifferentiated neoplasms. However, selection of antibodies must be judicious to make it cost effective.
- Cytomorphologic significance of marginal vacuoles in diffuse thyroid enlargements
Anshu Gupta, Manish Singhal, Shivani Kalhan, Atul Gupta, Onis Singhal, Viplesh Kaur
Journal of Cytology 2013 30(2):125-129
Background: Fine needle aspiration cytology (FNAC) of the thyroid is an established first-line test for thyroid lesions. Marginal vacuoles (MVs) have been associated with hyperactivity of the thyroid, but some studies have pointed towards their nonspecific status.
Aims: To assess the presence of MVs in diffuse thyroid enlargements and evaluate the strength of correlation between MVs, levels of thyroid hormone and cytological diagnosis.
Materials and Methods: Ninety-seven cases of diffuse thyromegaly were studied. Cytomorphological features were examined with special attention to MVs. MVs were graded as scant, moderate and abundant. Hormonal status of the patients was recorded. The presence and grading of MVs was correlated with cytological diagnosis and hormonal status. The strength of association was studied by applying the Chi-square test and test of proportion; a P ? 0.05 was considered significant.
≤ 0.05 was considered significant.
Results: Abundant MVs were not associated with hypothyroidism in this study; 79% of these cases were hyperthyroid. The correlation between moderate/insignificant MVs and functional status of the thyroid gland was inconclusive. Further, abundant MVs in thyroid FNACs were seen in cases of primary hyperplasia and Hashimoto's thyroiditis. There was a significant correlation between the presence of abundant/moderate MVs and primary hyperplasia and their absence in colloid goiter (P = 0.01 and 0.004, respectively).
Conclusions: A significant association was found between abundant MVs and a hyperthyroid state. Moderate/absent MVs in diffuse goiters were not found to correlate with thyroid function. Thus, all diffuse goiters with prominent MVs require hormonal evaluation to rule out hyperfunction of the thyroid.
- Pancreatic and peripancreatic tuberculosis presenting as hypoechoic mass and malignancy diagnosed by ultrasound-guided fine-needle aspiration cytology
RN Rao, Rakesh Pandey, Manoj Kumar Rana, Praveer Rai, Archna Gupta
Journal of Cytology 2013 30(2):130-135
Background: Pancreatic and peripancreatic tuberculosis is an extremely uncommon disease, presenting as hypoechoic mass on ultrasonography and imaging mimicking malignancy. Consequently, it represents a diagnostic challenge.
Aims: To study 14 unusual cases of pancreatic and peripancreatic tuberculosis undergoing ultrasound-/endoscopic-guided fine-needle aspiration cytology (FNAC) in the 5-year period from 2006 to 2010.
Materials and Methods: Endoscopic-guided FNAC was done in two cases, while ultrasound-guided FNAC was performed in 12 cases using 22-G needles via a percutaneous transabdominal approach. The aspirated material was quickly smeared onto glass slides, air dried, and wet fixed in 95% ethyl alcohol for subsequent Papanicolaou staining.
Results: All pancreatic and peripancreatic tuberculosis cases showed solid-cystic pancreatic mass. Smears showed epithelioid cell granulomas, multinucleated giant cells, mixed inflammatory cells and histiocytes against a necrotic background. The common anatomic locations were the head, peripancreatic, tail and body of the pancreas.
Conclusions: Ultrasound-/endoscopic-guided FNAC is a safe, reliable and cost-effective method for preoperative diagnosis of pancreatic and peripancreatic tuberculosis. Clinical symptoms and accurate diagnostic approach by ultrasound-/endoscopic-guided FNAC of pancreatic and peripancreatic tuberculosis is needed to avoid performing redundant laparotomy. Despite its rarity, pancreatic and peripancreatic tuberculosis should be considered for differential diagnosis of pancreatic and peripancreatic cystic mass in endemic developing countries.
- Metastatic appendiceal goblet cell carcinoid masquerading as mucinous adenocarcinoma in effusion cytology: A diagnostic pitfall
Anuja Gupta, Trupti Patel, Parul Dargar, Manoj Shah
Journal of Cytology 2013 30(2):136-138
Goblet cell carcinoids are rare tumors of appendix having a mixed phenotype, with partial neuroendocrine differentiation and intestinal type goblet cell morphology. The reported incidence of this tumor is still limited. Till now, only two cases of metastatic goblet cell appendiceal carcinoid on effusion cytology have been reported in literature. We describe the clinico-pathological details and lay stress on fluid cytology of metastatic goblet cell carcinoid to ascitic fluid.
- Post-burn duct carcinoma breast: An unusual case report
Neha Singh, Seema Rao, Shyama Jain
Journal of Cytology 2013 30(2):139-141
Malignancies arising from burn scars though rare are well documented in the literature; squamous cell carcinoma is the most common burn scar neoplasm, and adenocarcinoma is an extremely uncommon and rarely reported tumor in these scars. We hereby report a case of a young woman who presented with a rapidly growing lump in a scar in the mammary region that sustained severe burns 20 years back. It was diagnosed as duct carcinoma breast on cytology and later confirmed on histopathology and immunohistochemistry. The case mandates regular follow-up of patients with post-burn scars, and any lump arising in that region should be promptly investigated.
- Tubulopapillary hidradenoma: A rare case with cytohistopathological correlation
Neha Kawatra Madan, Shilpi Agarwal, Manupriya Nain
Journal of Cytology 2013 30(2):142-144
Tubulopapillary hidradenoma is a rare adnexal neoplasm with only a few cases reported in literature. The tumor shows a female predominance with a wide age range and presents as a well-defined, non-tender nodule most often located on the scalp. Review of the literature yielded no fine-needle aspiration reports of the cytological features of the tumor. We report a rare case of tubulopapillary hidradenoma in a 30-year-old male, presenting with a scalp swelling. The cytomorphological features are described in detail with histopathological correlation.
- Skull base chordoma presenting as nasopharyngeal mass with lymph node metastasis
Bhawna Bhutoria Jain, Soma Datta, Suparna Ghosh Roy, Uma Banerjee
Journal of Cytology 2013 30(2):145-147
Spheno-occipital chordomas can rarely present as nasopharyngeal mass. Metastases occur only in advanced disease. They can pose a diagnostic dilemma when information about diagnosis of the primary tumor is not available. We present cytological findings in upper cervical lymph node of a case of nasopharyngeal chordoma and discuss possible differential in such a location.
- Role of imprint cytology in intra-operative diagnosis of an unusual variant of teratoma
K Subitha, Renu thambi, S Sheeja, V Letha
Journal of Cytology 2013 30(2):148-149
- Comparative evaluation of six cytological grading systems in breast carcinoma
Kaushik Saha, Gargi Raychaudhuri, Bitan Kumar Chattopadhyay, Indranil Das
Journal of Cytology 2013 30(2):87-93
Background: Cytological grading is a useful tool for selection of therapy and prognosis in breast carcinoma. Despite having many cytological grading systems, there is still no agreement among pathologists to accept one of them as a gold standard.
Aim: This study was undertaken to evaluate six such three-tier cytological grading systems to determine which system corresponds best to histological grading done by Nottingham modification of Scarff Bloom Richardson (SBR)'s method.
Materials and Methods: In a double-blind study, preoperative cytological grades obtained by six systems on fine-needle aspiration cytology (FNAC) smears were compared by testing concordance, association and correlation with histological grade derived postoperatively by the SBR's method in 57 patients of breast carcinoma. Bivariate correlation studies and multiple linear regressions were done to assess the significance of the different cytological parameters to predict final cytological grades.
Results: Robinson's system demonstrated the best correlation (ρ = 0.799; P = 0.000 and τ = 0.765; P = 0.000), maximum percent agreement (77.19%) and a substantial kappa value of agreement (κ = 0.62) with the SBR's grading system. All the six cytological grading systems correlated with histological grading strongly and positively. In multiple regression analysis, all of the cytological parameters of Robinson's system except cell size and nucleoli had significance in predicting the final cytological grade.
Conclusions: Robinson's grading system is simple, more objective and reproducible, and demonstrated the best concordance with histological grading. So, Robinson's system should be used routinely for breast carcinoma aspirates.
- The Bethesda system for reporting thyroid fine needle aspirates: A cytologic study with histologic follow-up
Santosh Kumar Mondal, Simanti Sinha, Bijan Basak, Dipanwita Nag Roy, Swapan Kumar Sinha
Journal of Cytology 2013 30(2):94-99
Background: The Bethesda system for reporting thyroid cytopathology represents a major step towards standardization, reproducibility, improved clinical significance, and greater predictive value of thyroid fine needle aspirates (FNAs).
Aims: To elucidate the utility of the Bethesda system in reporting thyroid FNAs.
Materials and Methods: We retrospectively reviewed thyroid FNAs between April 2009 and March 2012, classified them using the Bethesda system, found out the distribution of cases in each Bethesda category, and calculated the malignancy risk for each category by follow-up histopathology.
Results: Of the 1020 FNAs, 1.2% were non-diagnostic, 87.5% were benign, 1% were atypical follicular lesion of undetermined significance (AFLUS), 4.2% were suspicious for follicular neoplasm (SFN), 1.4% were suspicious for malignancy (SM), and 4.7% malignant. Of 69 cases originally interpreted as non-diagnostic, 12 remained non-diagnostic after re-aspiration. In 323 cases, data of follow-up histopathologic examination (HPE) were available. Rates of malignancy reported on follow-up HPE were non-diagnostic 0%, benign 4.5%, AFLUS 20%, SFN 30.6%, SM 75%, and malignant 97.8%.
Conclusions: Reviewing the thyroid FNAs with the Bethesda system allowed a more specific cytological diagnosis. In this study, the distribution of cases in the Bethesda categories differed from some studies, with the number of benign cases being higher and the number of non-diagnostic and AFLUS cases being lower. The malignancy risk for each category correlated well with other studies. The Bethesda system thus allows standardization in reporting, improves perceptions of diagnostic terminology between cytopathologists and clinicians, and leads to more consistent management approaches.
VOL 30 NUMBER 3 (2013)
- CD 99 immunocytochemistry in solid pseudopapillary tumor of pancreas: A study on fine-needle aspiration cytology smears
Ranajoy Ghosh, Saumya R Mallik, Sandeep R Mathur, Venkateswaran K Iyer
Journal of Cytology 2013 30(3):151-155
Background: Solid pseudopapillary tumor of pancreas (SPTP) is a rare pancreatic tumor of uncertain histogenesis usually affecting young women. Though these tumors have characteristic cytomorphology, it is sometimes difficult to differentiate them from neuroendocrine tumors of the pancreas. We reviewed cases of SPTP to delineate the diagnostic cytological features and also observed utility of CD 99 (MIC 2) immunostaining to aid in the diagnosis of this tumor.
Aims: This study was designed to demonstrate the utility of CD 99 immunostaining along with cytological features for making a pre-operative diagnosis and delineating it from the neuroendocrine tumor of pancreas which is a close mimic.
Materials and Methods: Cytomorphological features of 11 cases of solid pseudopapillary neoplasm diagnosed by pre-operative fine-needle aspiration cytology (FNAC) at our institute were reviewed. Immunocytochemistry for CD 99 was also performed on the smears.
Results: All the cases had cellular smears with monomorphic cells lying singly, as loosely cohesive clusters as well as forming delicate pseudopapillae. Presence of intra and extra-cellular basement membrane material, background foamy macrophages and nuclear grooves were the other salient features. Immunocytochemistry for CD 99 could be performed on eight cases and demonstrated typical paranuclear dot-like positivity.
Conclusions: Pre-operative early diagnosis of SPTP can be made by FNAC which can further be aided by CD 99 immunocytochemistry.
- Clinical significance of benign endometrial cells found in papanicolaou tests of Turkish women aged 40 years and older
Gozde Kir, Ahmet Gocmen, Handan Cetiner, Cumhur Selcuk Topal, Muberra Segmen Yilmaz, Murat Hakan Karabulut
Journal of Cytology 2013 30(3):156-158
Background: Spontaneously exfoliated benign-appearing endometrial cells (BEC) on a Papanicolaou smear might indicate endometrial pathology in postmenopausal women, necessitating further investigation. A cut-off age of 40 years was included in the Bethesda System 2001 based on studies of clinical significance of endometrial cells in Pap smears in Western countries.
Aims: The purpose of this study was to determine the significance of age subgroup for women with a cytological diagnosis of BEC, regardless of menopausal status, in a retrospective cohort of Turkish women.
Materials and Methods: Between October 2006 and November 2011, 41 patients with a BEC diagnosis and 64 patients with a cytological diagnosis of normal smear (NS) were enrolled; regardless of menopausal status, these women were
40 years and older and for whom follow-up endometrial biopsies had been performed.
Results: On subsequent histopathologic evaluation, no malignant lesion was detected in women aged 40-50 years compared to three endometrioid-type adenocarcinomas in women older than 50 years with cytological diagnosis of BEC. There was a significant difference between women older than 50 years with cytologic diagnosis of BEC and NS in relation to premalignant lesions on histopathologic evaluation; however, this was not the case for women aged 40-50 years.
Conclusions: According to our study, reporting BEC for women aged between 40 and 50 years has minor clinical significance but is significant for women older than 50 years, regardless of menopausal status. Larger sample size would be appropriate to confirm the results of the current study.
- Plastic spatula with narrow long tip provides higher satisfactory smears for Pap test
Pervinder Kaur, Pralhad Kushtagi
Journal of Cytology 2013 30(3):159-161
Background: Ayre spatula for cervical smear collection is being used despite the suggestion that different modified spatulas provide more satisfactory sampling.
Aims: To see whether the cytological pickup improves with the use of long tipped spatula.
Setting and Design: Rurally based University Hospital; crossover study.
Materials and Methods: Pap smear using Ayre spatula in 500 and with plastic narrow long tip (Szalay) spatula in 500 clinic attending women was taken and analyzed. Crossover smears were taken with modified spatula in 163 and using Ayre spatula in 187 women after 2 weeks of initial smears. The same pathologist made cytological reporting for all smears and was unaware of the type of spatula used.
Results: Smears from Ayre spatula had significantly higher reports of inadequate smears (94 of 500 vs. 68 of 500 for Ayre and Szalay, respectively; P = 0.032) and it remained so even after crossover (94 of 187 vs. 70 of 163 for Ayre and Szalay, respectively; P = 0.2). Cellular quality appeared better with smears taken using Szalay spatula, but the overall abnormal smear detection rate remained similar with either collection tool (χ2 = 1.5; P = 0.2).
Conclusions: Proportion of satisfactory smears is higher when long tip plastic spatula is used for collection of sample.
- Role of biliary tract cytology in the evaluation of extrahepatic cholestatic jaundice
Mamta Gupta, Radha R Pai, Devi Dileep, Sandeep Gopal, Suresh Shenoy
Journal of Cytology 2013 30(3):162-168
Background: Endoscopic evaluation is critical in assessing the cause of obstructive jaundice. Cytological techniques including bile aspiration and biliary brushings have become the initial diagnostic modality.
Aim: The aim of this study is to evaluate the role of endoscopic biliary tract cytology as a diagnostic tool in the evaluation of extrahepatic cholestatic jaundice.
Materials and Methods: A total of 56 biliary tract specimens including 34 bile aspirations and 22 biliary brushings from 41 consecutive patients who had presented with obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography (ERCP) were assessed by cytological examination. The smears prepared were analyzed for standard cytological features.
Results: Cytologic diagnosis was adenocarcinoma in 13 (31.7%) cases, atypical in 2 (4.9%), reactive in 3 (7.3%) and benign changes in 19 (46.3%) cases. 4 (9.8%) cases were non-diagnostic. Serum bilirubin was significantly elevated in the malignant group. Biliary stricture was the most common finding on ERCP (68.3%). On cytological examination, presence of solitary, intact atypical cells, enlarged nuclei, irregular nuclear membrane, coarse chromatin and nucleoli were important cytologic criteria for differentiating malignant from benign biliary specimens.
Conclusions: Regular use of bile cytology and brushings during ERCP evaluation of extrahepatic cholestatic jaundice is invaluable in obtaining a morphologic diagnosis. A systematic approach, use of strict cytomorphologic criteria and inclusion of significant atypia as malignant diagnosis may improve the sensitivity.
- Demonstration of iron in exfoliated buccal cells of β-thalassemia major patients
Atul A Bhat, Rajkumar N Parwani, Sangeeta P Wanjari
Journal of Cytology 2013 30(3):169-173
Background: Thalassemia is a genetic disorder of hemoglobin synthesis, which requires regular blood transfusion therapy leading to iron overload in the body tissues. Transfusional hemosiderosis is a major cause of morbidity and mortality in these patients. Reliable methods for evaluation of iron overload are either invasive, costly or remotely available. Therefore, a simple technique of monitoring iron overload is desirable.
Aim: To know whether iron can be demonstrated in exfoliated buccal cells of β-thalassemia major patients using Perls' Prussian blue method and to correlate it with serum ferritin levels.
Materials and Methods: Smears were obtained from buccal mucosa of 60 randomly selected β-thalassemia major patients and 30 healthy subjects as controls. Smears were stained with Perls' Prussian blue method. Blood samples were taken for estimation of serum ferritin levels.
Statistical Analysis: Chi-square, Mann-Whitney, and Spearman Rank's Correlation tests.
Results: Perls' positivity was observed in 71.7% of thalassemic patients with a moderately positive correlation to serum ferritin levels.
Conclusion: Oral exfoliative cytology can be a useful tool in demonstration of iron overload in thalassemic patients, however, further research in this field in the direction of quantification of these procedures is required, which can establish this non-invasive procedure as an ideal screening tool.
- Alteration in buccal mucosal cells due to the effect of tobacco and alcohol by assessing the silver-stained nucleolar organiser regions and micronuclei
Sachin Jindal, Ishita Chauhan, Harshaminder Kaur Grewal
Journal of Cytology 2013 30(3):174-178
Background: Oral habits such as alcohol consumption and tobacco chewing are considered to be initiators of dysplastic changes in the oral mucosa.
Aim: The aim of this study was to determine and compare the alteration in apparently normal buccal mucosal cells due to effect of alcohol and tobacco by assessing silver-stained nucleolar organiser regions (AgNORs) and micronuclei.
Materials and Methods: The study comprised a total of 100 subjects which were divided into four groups with 25 subjects having alcohol consuming habit, 25 subjects were tobacco consumer, 25 were both alcohol and tobacco consumer and 25 formed control group who neither consumed alcohol nor tobacco. Two cytological smears were taken from each subject with the help of cytological brush. The smear was then wet fixed and stained with AgNOR and acridine orange staining technique and assessed for nucleolar organiser region and micronuclei count respectively. 500 cells per slide were counted to note the changes.
Results: Mann-Whitney test was applied to assess the variation in the number of AgNORs and micronuclei count between different groups. Cytological changes in each group revealed the increase in mean AgNORs and micronuclei count in subjects with combined alcohol and tobacco consumption when compared with individual groups.
Conclusions: Tobacco and alcohol consumption produce alteration in apparently normal buccal mucosal cells, which may cumulatively lead to carcinomatous changes. Result of these changes may be used as educational tool in cessation of habits.
- Analyzing agreement patterns of intraoperative central nervous system lesion reporting according to type and grade
Sujata Chaturvedi, Ishita Pant, Rakesh Dua, Sanjeev Gupta
Journal of Cytology 2013 30(3):179-184
Background: Neuropathology centers are expected to offer a prompt and accurate intraoperative diagnosis regarding tumor/lesion type and grade on fresh unfixed tissue. Level of diagnostic accuracy according to type and grade and also, the experience at a new center has not been reported before.
Aims: The aim of this study is to review the agreement patterns according to tumor/lesion type and grade between intraoperative and final histopathologic diagnosis in central nervous system (CNS) lesion samples received by a newly established neuropathology center at a tertiary care neuropsychiatric hospital.
Materials and Methods: Agreement between intraoperative and final histopathologic diagnosis was classified as: (I) Grade in agreement but type not in agreement; (II) grade not in agreement but type in agreement; (III) grade and type both not in agreement; (IV) grade and type both in agreement.
Statistical Analysis: Confidence interval (CI) of agreements was calculated for various categories of neoplastic as well as non-neoplastic lesions. CI was also calculated for groups where n × p and n × (1 − p) were more than 5, i.e., fulfilled the requirement of the central limit theorem.
Results: On retrospective analysis of 333 cases, 284 (85.3%) cases were categorized as neoplastic while 49 (14.7%) cases were categorized as non-neoplastic. Among the neoplastic lesions agreement was seen in 237 (83.5%) cases while 47 (16.5%) cases showed disagreement. Similarly in non-neoplastic category; 46 (93.9%) cases showed agreement while 3 (6.15%) cases showed disagreement. Of the non-neoplastic lesions, one case fell into the agreement category I, 2 in category III and 46 in IV. Among neoplastic lesions, there were 21 cases in agreement category I, 17 in II, 9 in III and 237 in IV. On analyzing the accuracy of intraoperative reporting according to tumor type, the break up was: - Astrocytic: 2 (I), 16 (II), 2 (III), 86 (IV); oligodendroglial: 8 (I), 1 (II); ependymal: 2 (III), 6 (IV); embryonal: 23 (IV); cranial and spinal nerve tumors: 2 (II), 21 (IV); choroid plexus tumors: 4 (IV); meningeal tumors: 3 (I), 1 (III), 49 (IV); metastatic tumors: 3 (I), 17 (IV); cysts (tumor-like conditions): 14 (IV); neuronal and mixed neuronal glial tumors: 1 (III); malignant lymphoma: 1 (III); sellar tumors: 17 (IV); and mixed gliomas: 5 (I).
Conclusions: This study identifies problem areas of CNS intraoperative reporting, in a new center, with reference to tumor typing and grading. It may forewarn upcoming centers of neuropathology about the potential problem areas of intraoperative reporting.
- Immature germ cells in semen - correlation with total sperm count and sperm motility
Priya S Patil, Rajendra S Humbarwadi, Ashalata D Patil, Anita R Gune
Journal of Cytology 2013 30(3):185-189
Background: Current data regarding infertility suggests that male factor contributes up to 30% of the total cases of infertility. Semen analysis reveals the presence of spermatozoa as well as a number of non-sperm cells, presently being mentioned in routine semen report as "round cells" without further differentiating them into leucocytes or immature germ cells.
Aim: The aim of this work was to study a simple, cost-effective, and convenient method for differentiating the round cells in semen into immature germ cells and leucocytes and correlating them with total sperm counts and motility.
Materials and Methods: Semen samples from 120 males, who had come for investigation for infertility, were collected, semen parameters recorded, and stained smears studied for different round cells. Statistical analysis of the data was done to correlate total sperm counts and sperm motility with the occurrence of immature germ cells and leucocytes. The average shedding of immature germ cells in different groups with normal and low sperm counts was compared. The clinical significance of "round cells" in semen and their differentiation into leucocytes and immature germ cells are discussed.
Conclusions: Round cells in semen can be differentiated into immature germ cells and leucocytes using simple staining methods. The differential counts mentioned in a semen report give valuable and clinically relevant information. In this study, we observed a negative correlation between total count and immature germ cells, as well as sperm motility and shedding of immature germ cells. The latter was statistically significant with a P value 0.000.
- Value of high-risk human papillomavirus 16 deoxyribonucleic acid testing with cytological entities in peri and postmenopausal women
Veena Kashyap, Suresh Hedau
Journal of Cytology 2013 30(3):190-194
Background: Genital human papillomavirus (HPV) infection is a sexually transmitted disease that is caused by HPV. Some types of HPV, called high-risk (HR) types may cause cell changes that sometimes lead to cervical cancer. HPV screening has been proposed for symptomatic female population; however, Pap test is the main stay in low resource setting.
Aim: To detect HR HPV 16 positivity in perimenopausal and postmenopausal women and its association with cytological entities diagnosed on Pap smear.
Materials and Methods: Pap smears and cervical scrapes were collected from 230 women consisting of 120 perimenopausal women approaching menopause and 110 postmenopausal women with a cervix after cessation of menstruation and processed as per routine procedure for detection of HR-HPV 16 deoxyribonucleic acid (DNA). Cytologically abnormal HPV 16 negative cases were also tested for other HR-HPV types.
Results: Among the perimenopausal women 12 (10%) cases were positive for HR-HPV 16 consisting of 6 (5%) abnormal cases and 108 (90%) were HPV 16 negative consisting of 5 (4.1%) abnormal cases. However, among 110 postmenopausal women 14 (12.7%) were positive for HPV 16 DNA consisting of 6 (5.4%) abnormal cases and 96 (87.2%) were HPV 16 negative consisting of 4 (3.6%) abnormal cases. HPV 16 negative abnormal cases (9) were positive for low risk-HPV 6/11 consisting of atypical squamous cells (3) and low-grade squamous intraepithelial lesions-HPV (6).
Conclusions: There is not much variation in HPV 16 positive cases in peri and postmenopausal women. By combining HPV DNA testing with Pap smear more cases having potential for pre-cancer lesions may be detected; however, HPV test cannot replace the Pap smear in low resource setting.
- Fine-needle aspiration cytology of granular cell tumor: A report of two cases
Pampa Ch. Toi, Neelaiah Siddaraju, Debdatta Basu
Journal of Cytology 2013 30(3):195-197
Granular cell tumors (GCTs) are uncommon soft tissue tumors, which are difficult to diagnose merely on clinical examination. Being an effective first-line investigation, the fine-needle aspiration cytology (FNAC) plays a significant role in its pre-operative recognition. However, as the tumor is likely to mimic certain other lesions, a cytopathologist needs to be aware of its characteristic cytomorphology. We report two cases of GCT who presented with subcutaneous swellings in the left lower back and the right-sided anterior abdominal wall for 6 and 2 months, respectively. Both the patients had a clinical diagnosis of lipoma/neurofibroma. FNAC was done in both. In the first case a cytodiagnosis of xanthogranuloma was suggested and GCT in the second. Subsequent histologic examination of both showed features of GCT. FNAC would aid in presumptive diagnosis of GCT.
- Extramedullary hematopoiesis as a 'clue' to diagnosis of hepatoblastoma on fine needle aspiration cytology: A report of two cases
Renu Thambi, Lekshmi Devi, Krishna Balachandran, Usha Poothiode
Journal of Cytology 2013 30(3):198-200
Extramedullary hematopoiesis (EMH) evidenced by erythropoietic cells and megakaryocytes is a characteristic feature of hepatoblastoma (HB). The typical cytomorphology, the presence of EMH and associated clinical and radiological findings offer a reliable diagnosis of hepatoblastoma by fine-needle aspiration cytology (FNAC). We describe the cytologic features of hepatoblastomas and discuss the differential diagnosis in two children, aged 53 days and 19 years. The usefulness of EMH in differentiating HB from other small round cell tumors and well differentiated hepatocellular carcinoma (HCC) on cytology is highlighted.
- Acute lymphoblastic leukemia presenting as a breast lump: A report of two cases
Syed Besina, Zubaida Rasool, Nuzhat Samoon, Othman Salim Akhtar
Journal of Cytology 2013 30(3):201-203
Extra-medullary leukemic infiltration of the breast by acute lymphoblastic leukemia (ALL) is very rare. We report two cases of ALL presenting as breast masses and diagnosed on fine-needle aspiration (FNA). Our first patient, a post-partum 30-year-old female, developed bilateral breast lumps in her last trimester of pregnancy and complained of easy fatigability. Our second patient, a 14-year-old girl, presented with a right-breast lump of 1-week duration. She had received treatment for ALL 1 year back and had been in complete remission for the last 1 year. FNA of the breast nodules done in both the cases revealed diffuse infiltration by lymphoblasts. Subsequent hematological investigations confirmed bone marrow involvement by ALL in the first case and extra-medullary relapse in the second case. Fine-needle aspiration cytology (FNAC) is an easy and cost effective method for the early diagnosis of metastatic leukemic infiltration, avoiding unnecessary excisional biopsies in such cases.
- Pure primary signet ring cell carcinoma breast: A rare cytological diagnosis
Jashan Sandhu, VK Dubey, Manisha Makkar, Vijay Suri
Journal of Cytology 2013 30(3):204-206
Signet ring cell carcinoma (SRCC) of the breast is a rare tumor and it is classified by World Health Organization in 2003 classification under 'mucin producing carcinomas'. Pure form of SRCC breast is an extremely rare entity and very few cases have been reported in literature so far. We present a case of pure primary SRCC of the breast in a 70-year-old female, which was diagnosed on fine needle aspiration cytology. Cytological features generally show cellular smears with tumor cells showing eccentrically placed large, irregular nuclei showing indentations at places with cytoplasmic vacuoles. This case is being presented in view of its characteristic cytological features and its rarity.
- Fine-needle aspiration cytology of myoepithelial carcinoma of salivary gland: Diagnostic challenge to cytopathologist
Shelly Sehgal, Prashant Goyal, Sompal Singh, Awanindra Kumar
Journal of Cytology 2013 30(3):207-210
Myoepithelial carcinoma (MC) is rare malignant salivary gland neoplasm and its cytologic features have been rarely described in the literature. Furthermore, MC shows varied cell types and patterns leading to the wide range of differential diagnosis on cytology. Histopathology and immunohistochemistry (IHC) are necessary to make a definite diagnosis. A 37-year-old female presented with painless, progressive swelling in the infra-auricular region since 2 years. Fine-needle aspiration cytology was performed and cytological possibilities of cellular pleomorphic adenoma and myoepithelial cell neoplasm were rendered and patient was advised excision and histopathologic examination for final diagnosis and subtyping. Final diagnosis of MC was made on hematoxylin and eosin sections and IHC. MC is rare malignant salivary gland tumor showing a clinic-pathologic diversity. The cytological features of MC are diverse and may lack overt feature of malignancy. Pathologists should be aware of this entity while evaluating cytological smears of salivary gland mass.
- Cytohistomorphology of subcutaneous phaeohypomycosis
Manisha Mohapatra, Sridhara Satyanarayana
Journal of Cytology 2013 30(3):211-212
Phaeohypomycosis is a clinical syndrome caused by melanised or dematiaceous fungi characterized by the presence of brown mycelial structures in tissue section. These fungi are associated with a repertoire of the clinical manifestations that includes superficial and deep local infection to disseminated infection. Herein, we describe the clinical and fine-needle aspiration cytology and histopathologic features of a case of subcutaneous phaeohypomycosis.
- Cytological diagnosis of Castleman's disease of the soft tissue
Manmeet Kaur Gill, Vijay Suri, Vijay K Dubey, Manisha Makkar
Journal of Cytology 2013 30(3):213-215
Castleman's disease (CD), a rare benign disease is characterized by lymphoid hyperplasia of uncertain etiology that may present as a nodal or extranodal mass. We describe herein a rare case of CD occurring in the soft-tissue of right arm in a 55-year-old woman. The present case is instructive in the differential diagnosis of primary soft-tissue tumors, for which the possibility of CD should be considered. 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 findings may not always be conclusive in all cases. We studied aspirates which revealed reactive hyperplasia with increased vascularity. Excision confirmed the diagnosis.
- Pulmonary echinococcosis with Actinomycetes-like organisms mimicking malignancy: Diagnosed by fine needle aspiration cytology
Nalini Gupta, Sangeeta Verma, Pinaki Dutta, Diveyesh Mahajan, Naveen Kalra
Journal of Cytology 2013 30(3):216-217
- Donovanosis: An incidental finding on Pap test
Shailja Puri Wahal, Deepak Tuli
Journal of Cytology 2013 30(3):217-218
- Aspiration cytology in the preoperative diagnosis of granular cell tumor of thyroid region in an 11-years-old female child
Suman Singh, Neelam Gupta, Shivani Sharma, Ramesh K Azad
Journal of Cytology 2013 30(3):218-219
- Role of cerebrospinal fluid cytology in 'carcinomatous meningitis' masquerading as 'tuberculoma'
Pampa Ch. Toi, Neelaiah Siddaraju, Rajesh Nachiappa Ganesh
Journal of Cytology 2013 30(3):220-221