Journal of Cytology
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   Table of Contents - Current issue
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April-June 2020
Volume 37 | Issue 2
Page Nos. 67-115

Online since Thursday, April 23, 2020

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REVIEW ARTICLES  

Indian academy of cytologists national guidelines for cytopathology laboratories for handling suspected and positive COVID-19 (SARS-COV-2) patient samples Highly accessed article p. 67
Radhika Srinivasan, Parikshaa Gupta, Bharat Rekhi, Prabal Deb, Vijay S Nijhawan, Dev Prasoon, Venkat Iyer, Sandeep Mathur, Nalini Gupta, Meherbano Kamal, Madhu Mati Goel, Indranil Chakrabarti, Madhusmita Jena, Ram Nawal Rao, Arvind Rajwanshi, Siddaraju Raju, Surendra Verma, RGW Pinto
DOI:10.4103/JOC.JOC_44_20  
COVID-19, caused by the SARS-CoV-2 virus, has been declared a pandemic by the World Health Organization. This scenario has impacted the way we practice cytopathology. Cytology laboratories receive fresh and potentially infectious biological samples including those from the respiratory tract, from COVID-19 positive or suspected patients. Hence, the Indian Academy of Cytologists thought it necessary and fit to bring forth appropriate guidelines starting from transportation, receipt, processing, and reporting of samples in the COVID-19 era. The guidelines are prepared with the aim of safeguarding and protecting the health care personnel including laboratory staff, trainees and cytopathologists by minimizing exposure to COVID-19 so that they remain safe, in order to able to provide a continuous service. We hope that these national guidelines will be implemented across all cytopathology laboratories effectively.
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Processing and reporting of cytology specimens from mediastinal lymph nodes collected using endobronchial ultrasound-guided transbronchial needle aspiration: a state-of-the-art review p. 72
Inderpaul Singh Sehgal, Nalini Gupta, Sahajal Dhooria, Ashutosh Nath Aggarwal, Karan Madan, Deepali Jain, Parikshaa Gupta, Neha Kawatra Madan, Arvind Rajwanshi, Ritesh Agarwal
DOI:10.4103/JOC.JOC_100_19  
Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is presently the preferred modality for sampling mediastinal lymph nodes. There is an unmet need for standardization of processing and reporting of cytology specimens obtained by EBUS-TBNA. The manuscript is a state-of-the-art review on the technical aspects of processing and reporting of EBUS-TBNA specimens. A literature search was conducted using the PubMed database, and the available evidence was discussed among the authors. The evidence suggests that at least one air-dried and one alcohol-fixed slide should be prepared from each lymph node pass. The remaining material should be utilized for microbiological analysis (in saline) and cell block preparation (10% formalin or other solutions). Wherever available, rapid-onsite evaluation should be performed to assess the adequacy of the sample and guide the need for additional material. The lymph node aspirate should also be collected in Roswell Park Memorial Institute solution in cases where lymphoma is under consideration. The use of liquid-based cytology provides good quality specimens that are free from blood and air-drying artifacts and can be used wherever available. Sample adequacy and the diagnostic category should be furnished separately in the cytology report.
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To evaluate the role of p16ink4a immunocytochemistry for detection of cin2+ in women detected screen positive by visual inspection using acetic acid p. 82
Lalita Verma, Saritha Shamsunder, Sunita Malik, Rashmi Arora
DOI:10.4103/JOC.JOC_89_18  
Objective: To evaluate the role of p16Ink4a immunostaining for the detection of cervical intraepithelial neoplasia (CIN2+) in women who had a positive screening test using visual inspection with acetic acid (VIA). Methods: Opportunistic screening of women (30–50 years) coming to the gynecology clinic by VIA was performed; the screen-positive women were included in the study which had the institutional review board (IRB) approval. A cytology slide for p16Ink4a immunostaining, colposcopy, and biopsy was then performed sequentially. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of p16Ink4a immunocytochemistry were evaluated with histopathology as the gold standard. Results: p16Ink4a positivity showed a linear correlation with the increasing grade of CIN. p16Ink4a positivity was seen in 6% of CIN 1, 80% of CIN 2, 100% of CIN 3, and squamous cell carcinoma. The sensitivity and specificity of p16Ink4a immunocytochemistry for detecting CIN 2 or more was 87.5% (95%CI 61.65–98.45) and 97.06% (95%CI 84.67–99.93). Colposcopy had an equal sensitivity of 87.5% (95% CI 61.65–98.45) and specificity of 50% (95% CI 32.43–67.57), respectively. Conclusion: With high sensitivity and specificity, p16Ink4a immunocytochemistry could be a viable option for triaging VIA-positive women.
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ORIGINAL ARTICLES Top

Tumor cell representation by an improvised technique of fine-needle aspiration specimen acquisition and cell block preparation: Our experience in lung cancer cases in a peripheral center of eastern India p. 87
Anup Kr Boler, Shreosee Roy, Arghya Bandyopadhyay, Abhishek Bandyopadhyay, Mrinal Kanti Ghosh
DOI:10.4103/JOC.JOC_138_18  
Background: Being a minimally invasive diagnostic technique, Fine-Needle Aspiration Cytology (FNAC) has become the first-line test and corresponding aspirated material has become the target specimen for diagnosis and ancillary tests in lung carcinoma. Although the role of Cell Blocks (CBs) in diagnosis and in ancillary testing is well recognized in literature, limited attention has been paid to specimen procurement and triage in the preparation of CBs. In the present scenario, CBs are not consistently optimal because of its low cellularity. Aims: This study is aimed to describe an improvised technique of specimen acquisition and cell block preparation in CT-guided FNACs of lung carcinoma cases in a resource-constrained center and to assess its efficacy for optimal representation of cellularity, morphology, and architecture. Materials and Methods: Total 85 lung carcinoma cases undergoing CT-guided FNAC in our center from February 2017 to January 2018 were included in this study. 4 to 5 direct smears and subsequent CBs were made from material obtained by single pass. Cellularity of smears and corresponding cell blocks were assessed and categorized according to a scoring system (score 1 to 3 for number of cells <50, 50–100, >100, respectively). Preserved architecture and morphology were also assessed in smears and CBs. Results: The evaluated samples showed a cellularity score 3 in 65.4%CBs and score 2 in 24.7% CBs. Overall, 90.1% cell blocks had acceptable cellularity. Cell morphology was preserved in all CBs of acceptable cellularity, except for two adenocarcinoma, one squamous cell carcinoma, and one small cell carcinoma blocks. Cellular architecture was also preserved in all CBs of acceptable cellularity. Conclusions: This simple improvised technique of CB preparation optimized its cellularity, morphology, and architectural preservation, even after adequate cellular FNA smears.
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Milan system for reporting salivary gland cytopathology– An experience from Western Indian Population p. 93
Vaishali P Gaikwad, Chanda Anupriya, Leena P Naik
DOI:10.4103/JOC.JOC_156_19  
Introduction: Fine-needle aspiration cytology (FNAC) can be challenging to provide a precise diagnosis in salivary gland cytopathology due to diversity of lesions and cytomorphological convergence between the tumors and within the same tumor of salivary gland. The recently proposed Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a risk stratification-based classification system with an intrinsic risk of malignancy (ROM) for each diagnostic category, which aims to furnish useful information to the clinicians. This study was undertaken to evaluate the diagnostic utility and validity of MSRSGC. Methods and Material: In this retrospective study, FNAC done for all salivary gland lesions over a period of two years were retrieved. All cases were categorized according to MSRSGC and correlated with histopathological follow-up, wherever available. ROM was calculated for each category. Results: The cases belong to following categories: non-diagnostic (1.27%), non-neoplastic (30.38%), atypia of undetermined significance (5.06%), benign neoplasm (46.84%), salivary gland neoplasm of uncertain malignant potential (1.27%), suspicious for malignancy (1.27%), and malignant (13.92%). Out of 79 cases, 50.63% had follow-up. The ROM were 0% for category II and IVa, 50% for category III, and 100% for category IVb, V, and VI. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were recorded as 77.78%, 100%, 100%, 91.3%, and 93.33%, respectively. Conclusions: Application of MSRSGC has immense value for standardization of reporting of salivary gland FNAC. Our data corresponds to the studies done worldwide and recommends the use of MSRSGC for future diagnostic purposes.
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Fine-needle cytological characteristics of carcinoma breast with medullary or medullary-like features masquerading as dendritic reticulum cell sarcoma: An attempt to explore the reasons for erroneous cytologic interpretation p. 99
Dilip K Das, Shahed K Pathan, Zafar A Sheikh, Mrinmay K Mallik, Bency John, Fatma Mothaffer
DOI:10.4103/JOC.JOC_15_20  
Background: Infiltration of tumors by dendritic reticulum cells (DRC) reflects the host immune defense mechanism. We observed three breast carcinomas cases with dense tumor-infiltrating DRC and lymphocytes in fine-needle aspiration (FNA) smears, leading to cytodiagnosis or differential diagnosis of dendritic reticulum cell sarcoma (DRCS). An attempt was made to find out the reason behind such an erroneous interpretation. Materials and Methods: Between 2009 and 2014, two cases were diagnosed as DRCS of the female breast by FNA cytology and in one case possibility of DRCS was considered along with medullary breast carcinoma (MBC). We compare and contrast the cytomorphological features of these three cases with those of nine cytologically diagnosed MBC. Results: Cases diagnosed as DRCS or MBC showed singly dispersed tumor cells, nuclear pleomorphism, bare nuclei, prominent nucleoli, and presence of lymphocytes. There was no significant difference between the two groups for discohesive clusters, syncytial clusters, plasma cells, neutrophils, foamy histiocytes, and necrosis. However, there was significant difference for presence of cohesive clusters (0% DRCS and 100% MBC,P = 0.00485), severe degree (+++) of pleomorphism (100% DRCS vs. 11.1% MBC,P = 0.01818), +++ DRC (P = 0.04697), and DRC with ++ to +++ enlarged nuclei (P = 0.03333), and pleomorphic nuclei (P = 0.00833). Two of the three cytologically diagnosed DRCS cases proved to be MBC or MBC-like and one as invasive ductal carcinoma. Six of nine cytologically diagnosed MBC cases with histology proved to be invasive breast carcinomas. Conclusion: Criteria for cytodiagnosis MBC need a fresh look. Cases with numerous dendritic cells possibly represent MBC.
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IMAGES IN CYTOPATHOLOGY Top

Rapid onsite evaluation of unstained cytosmears: A vermi-surprise in the breast p. 108
Chetan Parashar, Anurag Gupta, Pradyumn Singh
DOI:10.4103/JOC.JOC_15_19  
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Fine-needle aspiration of malakoplakia presenting as a peri-rectal mass after intestinal transplant p. 110
Yiannis P Dimopoulos, Jay Zeck, B Kallakury
DOI:10.4103/JOC.JOC_141_19  
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LETTERS TO EDITOR Top

Is cytology of purulent aspirates imperative?: An instance of a periappendicular abscess p. 112
PV Santosh Rai, Saraswathy Sreeram, Ayush M Goel, Akshatha Bhat
DOI:10.4103/JOC.JOC_89_19  
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Unusual presentation of chronic myeloid leukemia in chronic phase as multiple soft tissue chloromas p. 114
Sunayana Misra, Kusum Gupta, Preeti Mathur, Poonam Rani
DOI:10.4103/JOC.JOC_142_19  
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