Journal of Cytology
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   Table of Contents - Current issue
October-December 2019
Volume 36 | Issue 4
Page Nos. 189-223

Online since Tuesday, October 1, 2019

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EUS-guided FNA in diagnosing pancreatic lesions: Strength and cytological spectrum p. 189
Neha Nigam, Archana Rastogi, Vikram Bhatia, Binit Sureka, Priyanka Jain, Chhagan Bihari
Introduction: Early and accurate diagnosis is paramount for improving the therapeutic efficacy of pancreatic cancers. Endoscopic ultrasonography–fine needle aspiration (EUS-FNA) cytology has come up with the advantage of an early and accurate diagnosis of pancreatic cancers. This study was conducted to analyze the spectrum of pancreatic lesions cytology, and appraise the diagnostic accuracy of EUS-FNA cytology for pancreatic solid and cystic lesions. Materials and Methods: This retrospective study includes 288 EUS-guided pancreatic FNA cases. Clinical data, laboratory tests, cytopathology, histopathology, and imaging reports were retrieved. The final diagnosis was based on EUS-FNA cell block and/or pathology in surgical specimens, with immunohistochemistry support. The results of EUS-guided FNA were compared with the final diagnoses to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Among 288 EUS-guided pancreatic FNA cases, 175 (62.0%) were malignant. The mean age was 57.8 ± 13.5 years and 50.1 ± 13.7 years, and the mean size of the lesion was 4.1 ± 1.8 cm and 2.2 ± 1.1 cm in malignant and benign groups, respectively. Sensitivity, specificity, PPV, and NPV of EUS-FNA cytology for solid malignant lesions were 98.3%, 95.1%, 98.3%, and 95.1%, and those for cystic lesions were 88%, 92.3%, 100%, and 100%. Diagnostic accuracy of EUS-FNA cytology for solid and cystic pancreatic lesions is 97.4% and 95.0%, respectively. In conclusion of the above; diagnosis of pancreatic solid and cystic malignancy can be assigned from a composite of the EUS-FNA cytology, cell block preparation and immunohistochemistry Diagnosis of pancreatic solid and cystic malignancy can be assigned from a composite of the EUS-FNA cytology, cell block preparation, and immunohistochemistry.
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Cytological diagnosis and misdiagnosis of nodular fasciitis p. 196
Deepa Rani, Arsh Gupta
Background: Nodular fasciitis (NF) is a rapidly growing, self-limiting, subcutaneous nodular cytologic exuberant fibroblastic/myofibroblastic proliferation prone to cytological misdiagnosis. Aims: This study aimed at finding out the utility of fine needle aspiration cytology (FNAC) from NF patients and to validate the diagnostic features. Materials and Methods: The study group comprised 11 cases diagnosed as NF on cytology or subsequent histology. Results: Out of 11 cases, 9 were cytologically diagnosed as NF. Two cases were misdiagnosed as sarcoma as proven histologically. Of the 9 cases of NF, spontaneous resolution occurred in 7 cases in 2–16 weeks; excisional biopsy was undertaken in the other 2 cases. Conclusion: On cytology, NF reveals hypercellular, polymorphic, dispersed cell population, which is most commonly misdiagnosed as sarcoma. For this reason, FNAC has to be correlated with clinical data and followed up for the anticipated spontaneous regression.
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Thyroid bethesda atypia of undetermined significance or follicular lesion of undetermined significance (aus/flus): A heterogenous group Highly accessed article p. 200
Priyanka Maity, Ashish Kumar Jha, Moumita Sengupta, Keya Basu, Uttara Chatterjee, Sujoy Ghosh
Background: The Bethesda system of reporting thyroid cytopathology (BSRTC) was introduced in 2007. The third category of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) poses difficulties for the pathologist, and different papers have been published varying the risks of malignancy. Aims: (1) Evaluation of the cytological features of thyroid lesions according to BSRTC. (2) After resection, correlation with histopathological report to evaluate the risk of malignancy (ROM) and the risk of neoplasm (RON). (3) Division of category III into six subgroups based on cytological findings and assessment of ROM and RON. Materials and Methods: A total of 282 patients with diagnosed thyroid lesions underwent fine-needle sampling under ultrasound guidance. Smears were prepared and stained with May–Grunwald–Giemsa stain and Papanicolaou stain. Results: Of 282 cases, there were 9 cases (3.1%) of category I, 157 cases (55.8%) of category II, 24 cases (8.5%) of category III, 20 cases (7.1%) of category IV, 14 cases (4.8%) of category V, and 58 cases (20.7%) of category VI. The RON was 60, 17.1, 63.1, 77.7, 91.7, and 98.2% and the ROM was 60, 14.3, 26.3, 38.9, 91.7, and 96.3% in categories I, II, III, IV, V, and VI, respectively. The RON was 0, 75, 50, 100, 66.6, and 100% and the ROM was 0, 25, 50, 100, 16.6, and 0% in subgroups 1, 2, 3, 4, 5, and 6, respectively. We have proposed a system of subgrouping AUS/FLUS that may help to dispel the confusion generated by an AUS/FLUS report, and provide with a more exact and reproducible diagnostic and prognostic tool.
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Contribution of cell block obtained by thoracentesis in the diagnosis of malignant pleural effusion p. 205
Filiz Guldaval, Ceyda Anar, Gülru Polat, Mine Gayaf, Melike Yüksel Yavuz, Ali Korkmaz, Ibrahim Onur Alici, Gülistan Karadeniz, Melih Buyuksirin, Zekiye Aydogdu
Aim: The aim of this study wass to compare the cytological features of pleural exudative fluids by conventional smear (CS) method and cell block (CB) method and also to assess the utility of the combined approach for cytodiagnosis of these effusions. Materials and Methods: In all, 113 pleural exudative fluid samples were subjected to evaluation by both CS and CB methods over a period of 2 years. Cellularity, architecture patterns, morphological features, and yield for malignancy were compared, using the two methods. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of malignancy were calculated for both the methods, using histology as a gold standard. Results: CB method provided higher cellularity, better architectural patterns, and additional yield for malignancy when compared with CS method. For 22 (40%) patients, histologic subtype was determined with CB especially for adenocarcinoma. The sensitivity, specificity, positive, and negative predictive values of cytology and CB were 48%, 100%, 100%, 67.8% and 59.2%, 100%, 100%, 72.8%, respectively. Conclusion: CB technique definitively increased detection of malignancy in pleural fluid effusion when used as an adjunct to CSs. Also, CB provides material suitable for molecular genetic analysis for targeted therapies especially in the treatment of adenocarcinoma.
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False paragonimus eggs in sputum cytology p. 209
Rafael Martinez-Giron, Cristina Martinez-Torre
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Degenerative signet ring cell change in a bile duct brushing p. 211
Richard L Cantley
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Malignant triton tumor diagnosed on fine needle aspiration cytology p. 213
Biswajit Dey, Adarsh Barwad, Neelaiah Siddaraju, Pampa Ch Toi
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Fine-needle aspiration cytology of mammary analog secretory carcinoma of the parotid gland: A diagnostic conundrum p. 215
Meera Balakrishnan, Smiley Annie George, Bahiya E Haji, Issam M Francis
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Cytological features of cutaneous granular cell tumor: A brief report p. 217
Shweta Pal, Neha Nautiyal, Kriti Kaira, Vivek Bharosay
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Cartilage cells – A potential mimicker of malignant cells in cerebrospinal fluid and a diagnostic pitfall p. 218
Anupama Arya
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Sarcina in sputum cytology in a patient of pulmonary tuberculosis p. 219
Biswajit Dey, Vandana Raphael, Amit Banik, Yookarin Khonglah
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Intraoperative flow cytometry for diagnosis of central nervous system lesions p. 221
Arpita Jindal
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Pleural effusion associate with rheumatoid arthritis: Diagnostic clues p. 222
Enrique Rodriguez-Zarco, Ana Vallejo-Benitez, Concepción Otal-Salaverri
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