Journal of Cytology
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   Table of Contents - Current issue
Coverpage
April-June 2017
Volume 34 | Issue 2
Page Nos. 73-126

Online since Friday, March 31, 2017

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ORIGINAL ARTICLES  

Evaluation of cytology in lung cancer diagnosis based on EBUS-TBNA p. 73
Zhengwei Dong, Hui Li, Hongbin Jiang, Chunyan Wu
DOI:10.4103/0970-9371.203567  
Aims: Endobronchial ultrasound (EBUS) is a relatively new modality that can be used to guide transbronchial needle aspiration (TBNA) of mediastinal lymph nodes. At present, researches on the sensitivity and specificity of cytopathology based on the EBUS-TBNA are deficient; therefore, we want to evaluate the value of cytology based on the EBUS-TBNA in this article. Materials and Methods: We reviewed the 379 cases that underwent the EBUS-TBNA in Shanghai Pulmonary Hospital from April 2010 to May 2011. Discarding the 139 cases with insufficient cells, we analyzed the remaining 240 cases that had enough cells on the smears. Statistical Analysis Used: The Statistical Package for the Social Sciences version 15.0 (SPSS Inc., Chicago, IL) was used for data analysis. A P value of <0.05 was considered significant. Results: We found that the cytologic diagnosis of sensitivity and specificity reached 94.52% and 95.12%, respectively. The sensitivity of squamous cell carcinoma, adenocarcinoma, and small cell carcinoma was up to 88.24%, 100.00%, and 96.00%, respectively. The specificity of squamous cell carcinoma, adenocarcinoma, and small cell carcinoma reached to 100.00%, 100.00%, and 99.25%, respectively. Conclusion: Here, we report that the cytological examination of EBUS-TBNA should be acknowledged as a simple, fast, and safe procedure that provides a reasonable sensitivity and specificity of diagnosis in lung cancer.
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Hypercellular round cell liposarcoma: A comprehensive cytomorphologic study and review of 8 cases Highly accessed article p. 78
Sanjay S Chufal, Kundan S Chufal, Prabhat Pant, Ghazala Rizvi, Hari S Pandey, Kedar S Shahi
DOI:10.4103/0970-9371.203574  
Background: Myxoid and round cell liposarcomas (RCL) are low and high-grade counterparts of a common subtype of liposarcomas (LPS), representing a histologic continuum. Aims: The aim was to study the cytomorphology of hypercellular RCL and to look for features that differentiate RCL from other sarcomas displaying round cells with myxoid change. Materials and Methods: Eight cases of hypercellular RCL were identified retrospectively in which round cell component constituted greater than 75% of the area. Cytomorphological features were studied in detail. Results: Four cases were predominantly composed of round cells, out of which 2 were entirely composed of round cells. Myxoid metachromatic stroma was absent in 2 cases, while it was present in ample amounts in the remaining 6 cases. Spindle cells were completely absent in 5 cases and lipoblasts were observed in a single case of RCL. Plexiform vascular capillaries were seen in 4 cases. Adherence of neoplastic round cells around thin capillaries (ANAC) was observed in 7 cases. Conclusions: Plexiform capillary plexus and ANAC should be separately evaluated. The latter feature is the most consistent one, and is an important clue to the adipocytic nature of the neoplasm when hypercellular round cell areas are aspirated. Confident diagnosis of hypercellular RCL can be made on the basis of this feature. Lipoblasts, although specific, are seen in few cases. The rest of the features are nonspecific and useful only in combination.
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Fine needle aspiration biopsy: An entrustable professional activity in cytopathology postgraduate training p. 84
Harresh B Kumar, Amir M Khan, Vinod K Arora, Navjeevan Singh
DOI:10.4103/JOC.JOC_67_16  
Context: In the context of competency-based medical education being advocated worldwide, fine needle aspiration biopsy (FNAB) is considered as an entrustable professional activity (EPA). There is no information regarding how much time and training are required to achieve a “competent level” for performing and documenting FNAB in the Indian context. Aim: To determine the time taken by an average postgraduate pathology trainee to become competent in performing FNAB with respect to history taking, clinical examination, and fine needle aspirate adequacy. Settings and Design: A descriptive, retrospective, chart-based audit was conducted in the Department of Pathology. Materials and Methods: FNAB chart records documented during 3 years of postgraduate training by a cohort of 13 postgraduate (PG) resident trainees admitted in 2010 were included in the study. Adequacy rates and criteria for adequacy were defined for the purpose of the study. Statistical analysis: Data was entered in MS Excel and analyzed using the Statistical Package for the Social Sciences version 20.0. The adequacy rates are presented as percentages and time taken to achieve adequacy rates as median values. Results: A total of 3272 charts were audited. Median time taken to achieve 85% adequacy rate for history taking, for clinical examination by the first and the second criteria, and for FNAB were 1 month, 1 month and 3.5 months, and 1 month, respectively. Conclusions: Although the mean time taken to achieve 85% adequacy rates for FNAB was 1 month, there was wide variation in the time durations between the residents to achieve this level.
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Cervical cytopathological changes among women with vaginal discharge attending teaching hospital p. 90
Magdi M Salih, Fatma Tage El Sir Alhag, Mohammed Ahmed Khalifa, Abdulla H El Nabi
DOI:10.4103/JOC.JOC_214_15  
Aims: To find cytology changes among women attending obstetrics and gynaecology clinic with complaints of vaginal discharges. Settings and Design: This descriptive hospital-based cytological study was conducted at the outpatient clinic of the obstetrics and gynaecology department. Materials and Methods: Two hundred women with complaints of vaginal discharge were selected. Their detailed histories were documented on a special request form. Pap smears were then obtained and sent for cytological examination to the cytopathology department. All low-grade squamous intraepithelial lesion (LSIL) cases were advised to follow-up with Pap smears in the next 6–12 months. Those with high-grade squamous intraepithelial lesion (HSIL) were further investigated by a cervical biopsy and managed accordingly. Statistical analysis used: The statistical analysis was performed using, the Statistical Package for Social Science (SPSS). Chi-square and cross-tabulation were used in this study. Results: The cytological examination of Pap smears showed no changes (i.e. negative findings) in 88 (44%) cases, while Candida species infection was the most prevalent, which was found in 67 (33.5%) of the cases. Bacterial vaginosis was found in 39 women (19.5%); 6 women (3%) were reported with dyskaryotic changes. Two cases were found to have LSIL and 4 women had HSIL. Conclusion: Infection is common among the illiterate group of women. Women with vaginal discharges should undergo screening tests for evaluation by cervical smear for the early detection of cervical precancer conditions. There is an urgent need to establish a screening program for cervical cancer in Sudan.
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Impact of SurePath® liquid-based preparation in cytological analysis of peritoneal washing in practice of gynecologic oncology p. 95
Ruchita Tyagi, Nalini Gupta, Priyanka Bhagat, Shalini Gainder, Bhavna Rai, LK Dhaliwal, Arvind Rajwanshi
DOI:10.4103/JOC.JOC_193_14  
Context: Peritoneal washing is performed for staging of gynecologic tumors to detect subclinical intraperitoneal metastases. Aim: The aim of the present study was to assess the impact of SurePathTM liquid-based cytology (LBC) in peritoneal washing in various gynecological malignancies. Settings and Design: An audit of peritoneal-fluid/washing (January 2012 to July 2013) was performed with corresponding gynecologic specimens. All peritoneal washings were processed using both conventional and LBC technique. Suspicious cases on cytology were reported along with gynecologic specimens. Results: There were a total of 393 peritoneal fluids. Eighty-three (21.1%) were positive for malignancy, and the corresponding histology was available in 352 (89.6%) cases. Sixty-nine positive samples had ovarian malignancies and 5 had uterine causes. There were 9 cases of peritoneal washings in which no histopathology was available. The most common cause of positive peritoneal cytology was ovarian serous carcinoma in 55/84 (65.5%) cases. Other causes included mucinous cystadenocarcinoma, dysgerminoma, squamous cell carcinoma in teratoma, yolk sac tumor, and granulosa cell tumor. Uterine causes included 2/45 (4.4%) cases of endometrioid adenocarcinoma, ¼ (25%) cases of clear cell carcinoma, ½ (50%) cases of carcinosarcoma, and ¼ (25%) cervix carcinoma. On review of positive cases (n = 83), 10 cases were identified, which had nil (n = 4) to low cellularity (<3 tumor clusters/smear; n = 6) on conventional smears, and were confirmed malignant on LBC. Conclusions: The most common ovarian malignancy causing positive peritoneal cytology is papillary serous carcinoma. Endometrioid adenocarcinoma rarely leads to positive peritoneal cytology. LBC technique leads to concentration of tumor cells causing reduction in false negative cases, especially in hemorrhagic and low-cellular cases.
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CASE REPORTS Top

Significance of pigmented urothelial and non-urothelial cells in voided urine specimens: A case report and review p. 101
Joseph Alan Kagan, Susan Wu, Svetoslav Bardarov
DOI:10.4103/0970-9371.203578  
We present a case of metastatic malignant melanoma to the urinary bladder diagnosed on a voided urinary cytology specimen in a patient who visited the emergency department complaining of right flank pain, and dark urine. The patient reported having previous episodes of kidney stones. Additionally, more detailed clinical history obtained after the cytological diagnosis, revealed a previous excision of malignant melanoma on the back 10 years ago. The diagnosis of metastatic malignant melanoma was based solely on voided urine cytology. While metastases of malignant melanoma to urinary bladder are well known, the significance of pigmented cells in voided urine specimens is not well documented. In this article we provide a discussion as well as a review of the literature about possible disease entities associated with pigment containing urothelial as well as non-urothelial cells.
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Fine needle aspiration cytology of solitary fibrous tumor of the orbit p. 104
Vani Krishnamurthy, S Suchitha, M Asha, GV Manjunath
DOI:10.4103/0970-9371.203569  
Solitary fibrous tumor (SFT) is a distinct and a rare spindle cell neoplasm, commonly known to occur in the pleura and other serosal sites. With the advent of immunohistochemistry, varied extraserosal sites are being recognized as common locations for this rare tumor. We report a case of SFT in a 50-year-old male patient who presented with multiple swellings in the eyelid, with emphasis on the cytological features.
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A rare tumor of salivary gland: Diagnostic Dilemma on fine needle aspiration cytology p. 107
Charu Agarwal, Manju Kaushal, Minakshi Bhardwaj
DOI:10.4103/0970-9371.203576  
Salivary gland cytopathology is a diagnostically challenging area with overlapping cytomorphological features between benign, malignant, and metastatic tumors. We report the case of 45-year-old male who presented with two swellings in right retroauricular and infraauricular region along with a palpable single right cervical lymph node. On ultrasonography of the neck, a possibility of malignant lesion was given. Contrast enhanced computed tomography of the head showed a large well-defined space occupying lesion in right temporooccipital region eroding the skull bone with both extra and intracranial extension. Fine needle aspiration was performed from both swellings and cervical lymph node. Based on cytological features and clinicoradiological examination, a possibility of metastasis from epithelial malignancy (adenocarcinoma) was suggested. The retroauricular region swelling was excised, and a diagnosis of salivary duct carcinoma was given on histopathology. In this article, we discuss the diverse presentation, cytomorphological features, and differential diagnosis of this rare salivary gland tumor.
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Cytodiagnosis of papillary carcinoma of the male breast: Report of a case with histological correlation p. 110
Ranjan Agrawal, Nitesh Mohan, Mithila Bisht, Parbodh Kumar
DOI:10.4103/0970-9371.203572  
Papillary lesions of the breast pose great diagnostic challenges on fine needle aspiration cytology (FNAC) due to overlapping features between benign and malignant entities. Preoperative cytodiagnosis is difficult. We present a case of a 52-year-old male who presented with a progressively increasing firm swelling in the left breast for 3 years. The nipple was eroded with ulceration and bleeding. Ultrasonography (USG) revealed a mass measuring 2.9 cm × 1.5 cm in the left breast. FNAC smears were hypercellular with ductal cells arranged in papillae and glandular clusters. At places, the cells had irregular nuclear membrane, prominent nucleoli, fine chromatin, scanty-to-moderate cytoplasm, and high nuclear-cytoplasmic ratio with pleomorphism. Histopathology of the excised swelling was consistent with intracystic papillary carcinoma (IPC) supported with immunohistochemistry markers. The case is being presented due to its rarity.
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Solitary fibular metastasis from nonsmall cell lung carcinoma p. 113
Mohammad Akram, Samreen Zaheer, Asif Hussain, Shahid A Siddiqui, Ruquiya Afrose, Saifullah Khalid
DOI:10.4103/0970-9371.203577  
Solitary bone metastasis to fibula in patients of lung carcinoma is a rare entity, with only four cases reported in literature. We, hereby, present a case of a 50 year-old-male who was given three cycles of chemotherapy for lung carcinoma with no distant metastasis but presented 2 months later with a fusiform, painful swelling around the knee that was clinically suspected to be inflammatory in nature but proved to be fibular metastasis on cytology. There was no evidence of skeletal metastasis on initial bone scan. He was given palliative radiotherapy for this with symptomatic relief.
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Cutaneous basal cell carcinoma with mixed histology: Cytomorphological features of two unusual cases p. 115
Surbhi Goyal, Ruchi Rathore, Sonal Sharma, Vinod Kumar Arora, Gopal Krushna Das, Archana Singal
DOI:10.4103/0970-9371.203566  
Cutaneous basal cell carcinoma (BCC) is a slow growing locally aggressive malignant tumor. It is usually diagnosed on histopathological examination of the excised biopsy. Recently, fine needle aspiration cytology (FNAC) is emerging as a simple alternative technique for rapid diagnostic work of nodular and plaque-like skin lesions. We report the cytomorphological features of two cases of cutaneous BCC having unusual clinical presentation and mixed histology (MH); emphasizing the diagnostic difficulties encountered on cytology, the plausible explanation and the precautions to keep in mind to avoid misdiagnosis.
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Leptomeningeal carcinomatosis in a patient with gallbladder carcinoma p. 118
Nisha Jose, Harsha Teja Perla, Ramya Iyadurai, Geeta Chacko
DOI:10.4103/0970-9371.203571  
Carcinomatous meningitis is a rare manifestation of malignancy. It is increasingly being recognized in lung carcinoma, breast carcinoma, melanomas, gastrointestinal malignancies, lymphomas, and leukemia and it is almost never seen in gallbladder malignancies. We present a case whose primary presentation was as a carcinomatous meningitis that was subsequently found to be secondary to a gallbladder primary.
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Littoral cell angioma of the spleen: Cytological findings and review of the literature p. 121
Mohammad H Anbardar, Perikala V Kumar, Hamid R Forootan
DOI:10.4103/JOC.JOC_118_15  
Littoral cell angioma (LCA) is a unique lesion of the spleen that arises from the cells lining the venous sinuses of the splenic red pulp and shows the features of combined endothelial and histiocytic differentiation. Several cases of LCA have been reported in the literature; however, the cytological findings have been described for only a few cases. We report the case of an 11-year-old boy with anemia, epigastric abdominal pain, and splenomegaly. The splenic lesions showed anastomosing vascular channels with cyst-like spaces filled by many sloughed endothelial cells, which were positive for CD68 and CD31 and negative for CD34. Scraping cytology revealed isolated and clusters of three-dimensional bland looking, epithelioid foamy tumoral cells with low nuclear cytoplasmic ratio, which mostly contained intracytoplasmic hemosiderin pigment. Although the fine needle aspiration cytology of splenic lesions is uncommon and LCA is a rare splenic lesion, it must be noted in the differential diagnosis of any splenic vascular neoplasm.
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LETTER TO EDITOR Top

Malignant mixed mullerian tumor of ovary-scrape cytology: Findings with review of literature p. 125
Amita J Gupta, Meeta Singh, Poonam Rani, Shyama Jain, Nita Khurana, Latika Sahu
DOI:10.4103/0970-9371.203568  
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