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REVIEW ARTICLE
Malignant small round cell tumors
Arvind Rajwanshi, Radhika Srinivas, Gautam Upasana
January-March 2009, 26(1):1-10
DOI
:10.4103/0970-9371.54861
PMID
:21938141
Malignant small round cell tumors are characterised by small, round, relatively undifferentiated cells. They generally include Ewing's sarcoma, peripheral neuroectodermal tumor, rhabdomyosarcoma, synovial sarcoma, non-Hodgkin's lymphoma, retinoblastoma, neuroblastoma, hepatoblastoma, and nephroblastoma or Wilms' tumor. Other differential diagnoses of small round cell tumors include small cell osteogenic sarcoma, undifferentiated hepatoblastoma, granulocytic sarcoma, and intraabdominal desmoplastic small round cell tumor. Differential diagnosis of small round cell tumors is particularly difficult due to their undifferentiated or primitive character. Tumors that show good differentiation are generally easy to diagnose, but when a tumor is poorly differentiated, identification of the diagnostic, morphological features is difficult and therefore, no definitive diagnosis may be possible. As seen in several study reports, fine needle aspiration cytology (FNAC) has become an important modality of diagnosis for these tumors. The technique yields adequate numbers of dissociated, viable cells, making it ideally suitable for ancillary techniques. Typically, a multimodal approach is employed and the principal ancillary techniques that have been found to be useful in classification are immunohistochemistry and immunophenotyping by flow cytometry, reverse transcriptase polymerase chain reaction (RT-PCR), fluorescence in situ hybridization (FISH), and electron microscopy. However, the recent characterization of chromosomal breakpoints and the corresponding genes involved in malignant small round cell tumors means that it is possible to use molecular genetic approaches for detection.
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ORIGINAL ARTICLES
Diagnostic utility of the cell block method versus the conventional smear study in pleural fluid cytology
Udasimath Shivakumarswamy, Surekha U Arakeri, Mahesh H Karigowdar, BR Yelikar
January-March 2012, 29(1):11-15
DOI
:10.4103/0970-9371.93210
PMID
:22438610
Background:
The cytological examinations of serous effusions have been well-accepted, and a positive diagnosis is often considered as a definitive diagnosis. It helps in staging, prognosis and management of the patients in malignancies and also gives information about various inflammatory and non-inflammatory lesions. Diagnostic problems arise in everyday practice to differentiate reactive atypical mesothelial cells and malignant cells by the routine conventional smear (CS) method.
Aims:
To compare the morphological features of the CS method with those of the cell block (CB) method and also to assess the utility and sensitivity of the CB method in the cytodiagnosis of pleural effusions.
Materials and Methods:
The study was conducted in the cytology section of the Department of Pathology. Sixty pleural fluid samples were subjected to diagnostic evaluation for over a period of 20 months. Along with the conventional smears, cell blocks were prepared by using 10% alcohol-formalin as a fixative agent. Statistical analysis with the 'z test' was performed to identify the cellularity, using the CS and CB methods. Mc. Naemer's χ
2
test was used to identify the additional yield for malignancy by the CB method.
Results:
Cellularity and additional yield for malignancy was 15% more by the CB method.
Conclusions:
The CB method provides high cellularity, better architectural patterns, morphological features and an additional yield of malignant cells, and thereby, increases the sensitivity of the cytodiagnosis when compared with the CS method.
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Effectiveness of the cell block technique in diagnostic cytopathology
Shehnaz Khan, Tanvier Omar, Pamela Michelow
July-September 2012, 29(3):177-182
DOI
:10.4103/0970-9371.101167
PMID
:23112458
Background:
One of the constraints of the conventional FNA smear is the limited material available for adjuvant diagnostic investigations including immunocytochemistry. The cell block technique employs the retrieval of small tissue fragments from a FNA specimen which are processed to form a paraffin block. It is widely accepted that cell block technique increases the cellular yield and improves diagnostic accuracy. The ability to obtain numerous tissue sections allows for multiple immunostains and other studies to be performed akin to paraffin sections produced in histopathology.
Aims:
To determine the effectiveness of the cell block technique by comparing cytomorphological preservation and immunocytochemistry (ICC) stains on paired cell block and conventional fine needle aspiration (FNA) samples.
Materials and Methods:
In this prospective study, material for both glass slides and cell blocks were collected simultaneously during fine needle aspirates from 47 samples comprising lung and liver masses. Grading of cellularity, morphological preservation, architectural preservation, immunocytochemical staining intensity and presence of background staining on paired FNA smears and cell block samples were compared. Each arm of the paired analysis was performed blindly without knowledge of the grading outcome of the other. The Kappa statistic (κ) was used to measure inter-rater agreement.
Results:
The 47 samples evaluated included FNAs from the lung, 24/47 (51%) and liver, 23/47 (49%). The immunocytochemistry stains consisted of 44/47 (94%) CK7; 44/47 (94%) CK20; 18/47 (38%) TTF1; 10/47 (21%) synaptophysin; 10/47 (21%) Hepar-1 and 7/47 (15%) AE1/3. There was no overall agreement in preservation of cytomorphological detail and ICC staining between the two methods. The Papanicolaou-stained conventional FNA smears fared better than the cell block for the evaluation of nuclear and morphologic characteristics. The ICC stains worked better on the cell block samples due to lack of background and aberrant staining.
Conclusion:
Direct FNA smears and cell blocks complement each other and our results indicate that both are needed in the diagnostic work-up of patients. The cost implications of performing both techniques on all FNA material warrants further evaluation.
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Role of fine needle aspiration cytology in diagnosis and management of thyroid lesions: A study on 434 patients
Uma Handa, Sukant Garg, Harsh Mohan, Nitin Nagarkar
January-March 2008, 25(1):13-17
DOI
:10.4103/0970-9371.40652
Objectives:
To evaluate the results of fine needle aspiration cytology (FNAC) in the diagnosis and management of thyroid lesions.
Materials and Methods:
A review was conducted of FNAC of diffuse or nodular thyroid lesions performed on 434 patients over a period of three years. The cytological results were correlated with clinical features, biochemical investigations, and subsequent histopathological examination and management of the patients.
Results:
The most frequently encountered lesion was the colloid goiter in 250 (57.60%) cases followed by thyroiditis in 119 (27.41%) cases, ten (2.30%) adenomatous goiters and two (0.004%) thyroglossal cysts. In the neoplastic group, 14 (1.38%) cases were reported as follicular/Hurthle cell neoplasms and 17 (3.91%) as malignant tumors. When compared with the clinical diagnosis, FNAC proved to be an improvement on the diagnosis of thyroiditis and malignancy when compared with that of goiter. FNA revealed a sensitivity of 97%, a specificity of 100%, a positive predictive value of 96% and a negative predictive value of 100%.
Conclusions:
FNAC is a minimally invasive, highly accurate and cost-effective procedure for the assessment of patients with thyroid lesions. It also helps in differentiating lesions that require surgery from those that can be managed otherwise.
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Efficacy of oral brush cytology in the evaluation of the oral premalignant and malignant lesions
M Babshet, K Nandimath, SK Pervatikar, VG Naikmasur
October-December 2011, 28(4):165-172
DOI
:10.4103/0970-9371.86342
PMID
:22090689
Objective:
In the present study, oral brush cytology of premalignant and malignant lesions was performed using tooth brush. The cytopathological diagnosis of brush cytology was compared with that of punch biopsy. The reliability of oral brush cytology using tooth brush was assessed in terms of sensitivity and specificity.
Materials and Methods:
A total of 67 patients, 32 premalignant lesions and other 35 frank oral carcinomas, were included in the study. All patients underwent oral brush cytology using a toothbrush followed by punch biopsy. Sensitivity, specificity, positive and negative predictive values were calculated. Cytopathology and histopathology of premalignant and malignant lesions were compared using Mann-Whitney
U
test. Inter- and intra-examiner reliability was calculated using Rank-correlation coefficient.
Results:
Two in premalignant group and five in malignant group were marked insufficient. 18% of cases were false negatives. The sensitivity, specificity, positive predictive value and negative predictive value were 77%, 100%, 100% and 38%, respectively. Statistical analysis showed
P
>0.05, suggesting that there is no significant difference between histopathology and brush cytology in assessing both premalignant and malignant lesions. Inter- and intra-examiner reliability were 99.22% and 99.77%, respectively.
Conclusion:
Brush cytology using a tooth brush is reliable and can be easily performed with less cost and discomfort to the patient. It is useful in those situations when a patient refuses to have a biopsy performed or when medically compromised patients would be exposed to unnecessary surgical risks. It can be used for screening for suspicious oral lesions, and may have applications in resource-challenged areas.
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Cytological diagnosis of microfilariae in filariasis endemic areas of eastern Uttar Pradesh
Shaila K Mitra, Rajiv K Mishra, Pallavi Verma
January-March 2009, 26(1):11-14
DOI
:10.4103/0970-9371.51333
PMID
:21938142
Background:
Filariasis is a major health problem in tropical countries including India. Fine needle aspiration cytology plays an important role in prompt recognition of disease.
Aim:
To assess the role of fine needle aspiration cytology (FNAC) in diagnosis of filariasis at all possible sites.
Materials and Methods
: Total 250 cases of superficial swellings at various sites were subjected to fine needle aspiration cytology.
Results:
Out of 250 cases, 24 cases of filariasis were detected which include breast lumps (8 cases), lymph nodes (6 cases), scrotal swellings (4 cases), thyroid swellings (3 cases), soft tissue swellings (2 cases) and ascitic fluid (1 case). Eosinophilia was present in 8 out of 24 cases with a percentage ranging from 12-24%. Significant adherence of inflammatory cells and macrophages to microfilariae was present in 3 out of 24 cases.
Conclusions:
In endemic areas, it should be considered one of the differential diagnoses of a superficial swelling. Careful screening of FNAC smears help in detecting microfilaria even in asymptomatic patients and thus plays a significant role in recognition of the disease and institution of specific treatment.
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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
April-June 2013, 30(2):94-99
DOI
:10.4103/0970-9371.112650
PMID
:23833397
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.
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Cytogenetic biomonitoring in petrol station attendants: A micronucleus study
Medhini Singaraju, Sasidhar Singaraju, RN Parwani, SP Wanjari
January-March 2012, 29(1):1-5
DOI
:10.4103/0970-9371.93208
PMID
:22438608
Background:
Benzene, which is a major organic product, on chronic exposure can result in many malignant disorders, and therefore exposure to gasoline vapors is classified by the International Agency for Research of Cancer as possible carcinogenic to humans. Petrol station attendants are chronically exposed to petroleum derivatives through inhalation of petrol during vehicle refuelling.
Aim:
This study is aimed to investigate cytogenotoxic damage in exfoliated buccal cells obtained from petrol station workers and control subjects using micronucleus (MN) test.
Materials and Methods:
This study was carried out on 30 petrol station attendants working at different petrol stations located in Indore. The control group consisted of 30 healthy subjects who were not exposed to benzene. Buccal cell samples were collected at the end of the work shift. Slides were stained and were evaluated to determine the MN frequencies. Exposure monitoring was performed by the detection of phenol excreted in the urine. Urinary phenol measurements were performed following the colorimetric quantitative determination method of Yamaguchi and Hayashi.
Results:
Variations in MN frequencies were seen in control and petrol bunk attendants.
Conclusion:
The MN test in exfoliated epithelial cells seems to be a useful biomarker of occupational exposure to genotoxic chemicals. Phenol is the principal metabolite of benzene. Therefore, phenol concentration in the urine of exposed workers can be used as a biomarker of external exposure.
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Critical analysis of cell block versus smear examination in effusions
Meenu Thapar, Rajiv K Mishra, Amit Sharma, Vikas Goyal, Vibhuti Goyal
April-June 2009, 26(2):60-64
DOI
:10.4103/0970-9371.55223
PMID
:21938154
Objectives:
To assess the utility of the cell block preparation method in increasing the sensitivity of cytodiagnosis of serous fluids and to know the primary site of malignant effusions.
Materials and Methods:
A total of 190 cases were subjected to routine smear examination as well as cell block preparation. After the cytological diagnosis, each case was objectively analysed for cellularity, arrangement (acini, papillae, cell balls, and proliferation spheres), cytoplasmic, and nuclear details.
Results:
Out of 190 cases, 70 cases were found to be malignant and had been examined in smears and paraffin-embedded cell blocks. Using a combination of the cell block and smear techniques yielded 13% more malignant cases than what were detected using smears by themselves. The combined technique helped to ascertain the primary site of malignancy in 83.3% of the cases, whereas the primary site could not be ascertained in 17.7% of the cases.
Conclusions:
The cell block technique not only increased the positive results, but also helped to demonstrate better architectural patterns, which could be of great help in making correct diagnosis of the primary site. The cell block technique was also useful for special stains and immunohistochemistry and can give morphological details by preserving the architectural patterns.
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Study of cytomorphology of solid pseudopapillary tumor of pancreas and its differential diagnosis
Neelam Mehta, Lopa Modi, Trupti Patel, Manoj Shah
October-December 2010, 27(4):118-122
DOI
:10.4103/0970-9371.73293
PMID
:21157561
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.
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Efficacy of liquid-based cytology versus conventional smears in FNA samples
Kalpalata Tripathy, Aparajita Misra, Joydip Kumar Ghosh
January-March 2015, 32(1):17-20
DOI
:10.4103/0970-9371.155225
PMID
:25948938
Background:
Liquid-based cytology (LBC) is fast becoming a useful method in evaluating both gynecological and non-gynecological preparations, including fine needle aspiration (FNA) cytology. Even distribution of cells, decreasing obscuring background elements like blood and mucus, well preserved nuclear and cytoplasmic details and rapid fixation helps in better visualization of cells.
Aim:
This study was conducted to asses the diagnostic accuracy of liquid-based cytology versus conventional smears in fine needle aspiration samples.
Study Design:
In this prospective study, we had 110 cases, including 30 cases of breast, 40 of lymph node, 10 of salivary glands, 18 of thyroid and 12 of bone and soft tissue. In each case, two passes were performed. The first pass was for conventional preparation (CP) and the second pass yielded material for thin-prep (TP) preparation. Both CP and TP smears were compared for cellularity, background blood and necrotic cell debris, cell architecture, informative background, presence of a monolayer of cells and nuclear and cytoplasmic details by a semiquantitative scoring system. Wilcoxon's signed rank test on an SPSS program was used for statistical analysis.
Results:
Diagnostic accuracy was better in LBC smears compared with CP smears due to lack of background debris and better cell morphology, which was performed according to Wilcoxon's signed rank test, yielding a
P
-value of <0.001. However, in some cases, because of a decrease in cell size, clustering and altered background in LBC, a support of CP was essential.
Conclusion:
LBC performed on FNA samples can be a simple and valuable technique. Only in few selected cases, where background factor is an essential diagnostic clue, a combination of both CP and TP is necessary.
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CASE REPORTS
Microfilaruria in a patient of intermittent chyluria
Ankit Seth
October-December 2009, 26(4):151-152
DOI
:10.4103/0970-9371.62186
PMID
:21938181
Besides peripheral blood smears, microfilariae have been described in aspirate smears from different sites. Identification of microfilariae in the chylous urine of otherwise asymptomatic filarial patients has been rarely described. One such case is presented.
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ORIGINAL ARTICLES
Micronuclei: An essential biomarker in oral exfoliated cells for grading of oral squamous cell carcinoma
Kiran Jadhav, Nidhi Gupta, BR Ahmed Mujib
January-March 2011, 28(1):7-12
DOI
:10.4103/0970-9371.76941
PMID
:21552400
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.
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Critical appraisal of cytological nuclear grading in carcinoma of the breast and its correlation with ER/PR expression
Vidhi Bhargava, Manjula Jain, Kiran Agarwal, S Thomas, Smita Singh
April-June 2008, 25(2):58-61
DOI
:10.4103/0970-9371.42445
Background:
Cytological nuclear grading is one of the several key prognostic factors that should be addressed in cytological analysis of breast carcinomas.
Aims:
To evaluate different cytological nuclear grading methods on fine needle aspirates of breast carcinomas and its correlation with histopathological nuclear grading as well as with the immunocytochemical expression of estrogen receptor (ER) and progesterone receptor (PR).
Materials and Methods:
The smears from 30 cytologically proven cases of breast carcinoma were graded by - Nottingham's modification of Scarff Bloom Richardson, Fisher's modification of Black's nuclear grading and Robinson's cytological grading methods. 18 cases were available for correlation with histology grading.
Results:
Robbinson's cytological grading system was found to have the best correlation with histopathology grades (
P
< 0.001) as well as ER (
P
= 0.003) and PR (
P
= 0.001) expression on smears.
Conclusions:
The Richardson's cytology grading method is recommended for cytological nuclear grading along with ER / PR expression, without which the cytological diagnosis of breast carcinoma is incomplete.
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CASE REPORTS
Retroperitoneal cystic schwannoma: A case report with review of literature
Aparna Narasimha, ML Harendra Kumar, R Kalyani, M Madan
October-December 2010, 27(4):136-139
DOI
:10.4103/0970-9371.73299
PMID
:21157565
The occurrence of retroperitoneal schwannoma is uncommon and its presence may only be expressed by insidious onset of nonspecific symptoms such as vague abdominal pain. Imaging modalities like computed tomography and magnetic resonance imaging may demonstrate the tumor, but due to heterogeneity and degeneration in some tumors, it may mimic malignancy. So, fine needle aspiration cytology followed by tissue sampling through needle biopsies may be essential to confirm the diagnosis prior to the surgery. This case is reported for its rare clinical presentation, having duration of more than 40 years with cystic degenerative changes.
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ALK-negative anaplastic large cell lymphoma mimicking a soft tissue sarcoma
Rachel Hudacko, Amy Rapkiewicz, Russell Scott Berman, Aylin Simsir
October-December 2011, 28(4):230-233
DOI
:10.4103/0970-9371.86362
PMID
:22090705
Anaplastic lymphoma kinase protein (ALK)-negative anaplastic large cell lymphoma (ALCL) has a vast morphologic spectrum and may mimic many other types of malignancies both cytologically and histologically. There are only a few published case reports/series describing the cytomorphologic features of ALCL on fine-needle aspiration (FNA) biopsy specimens. We describe a case of ALK-negative ALCL mimicking a high-grade soft tissue sarcoma of the thigh in a 62-year-old man. The characteristic morphologic findings on FNA and core biopsy along with the immunophenotypic profile are described and reviewed. The diagnosis of ALCL on FNA biopsy may be difficult, but can be done successfully with the use of ancillary tests. Therefore, it must be considered in the differential diagnosis of lesions with pleomorphism, anaplasia, and wreath-like or horseshoe-shaped nuclei to ensure that adequate material is obtained for ancillary studies.
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ORIGINAL ARTICLES
Detection of abnormal cervical cytology in Papanicolaou smears
Manjit Singh Bal, Rishu Goyal, Anil Kumar Suri, Manjit Kaur Mohi
January-March 2012, 29(1):45-47
DOI
:10.4103/0970-9371.93222
PMID
:22438616
Background:
Cervical cytology by Papanicolaou (Pap) smears is an effective means of screening for cervical premalignant and malignant conditions. Cervical intra-epithelial neoplasia (CIN) and cervical cancer remain important health problems for women worldwide.
Aim:
To study the role of Pap smear in detecting premalignant and malignant lesions of cervix; and to determine the prevalence of various lesions.
Materials and Methods:
This study is based on 300 patients who attended the out-patient Department of Obstetrics and Gynaecology. Pap smears were prepared from patients presenting with complaints like vaginal discharge, post-coital bleeding, inter-menstrual bleeding, dyspareunia, and pain lower abdomen. After fixation and staining, each smear was carefully examined.
Results:
Epithelial cell abnormalities were found in 5% smears, atypical squamous cells of undetermined significance (ASCUS) in 0.3%, squamous intraepithelial lesion (SIL) in 3.4% which includes low grade squamous intraepithelial lesion (LSIL) (2.7%) and high grade squamous intraepithelial lesion (HSIL) 0.7%. Invasive carcinoma was seen in 1.3% cases. Mean age of the patients with diagnosis of LSIL was 32.3 years and for HSIL, it was 40.5 years. The mean age of the patients with invasive carcinoma was 57 years.
Conclusion:
Premalignant and malignant lesions of cervix are not uncommon in our set up and can be diagnosed early by Pap smears.
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Fine needle aspiration cytology of pilomatrixoma
Cherry Bansal, Uma Handa, Harsh Mohan
January-March 2011, 28(1):1-6
DOI
:10.4103/0970-9371.76940
PMID
:21552399
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.
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Fine needle aspiration cytology of supraclavicular lymph nodes: Our experience over a three-year period
Sumit Mitra, Suchandra Ray, Pradip K Mitra
July-September 2011, 28(3):108-110
DOI
:10.4103/0970-9371.83465
PMID
:21897543
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.
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Distinction of phyllodes tumor from fibroadenoma: Cytologists' perspective
Ranjana Bandyopadhyay, Dipanwita Nag, Santosh Kumar Mondal, Subhalakshmi Mukhopadhyay, Sumit Roy, Swapan Kumar Sinha
April-June 2010, 27(2):59-62
DOI
:10.4103/0970-9371.70739
PMID
:21157551
Background:
Fibroadenomas and phyllodes tumors may have similar cytological appearances. However, a detailed study of cytomorphology of stromal elements may be helpful in differentiation.
Aim:
To evaluate the cytological features of phyllodes tumor in our study with special reference to features that can help distinguishing it from fibroadenoma.
Materials and Methods:
The archival materials of our hospital were searched from January 2006 to January 2009 for histopathologically-diagnosed cases of phyllodes tumor. The cases in which previous cytopathology smears were available were included in the study. The cytomorphology of 10 such cases were compared with 25 cytologically-diagnosed and histopathologically-confirmed cases of fibroadenoma.
Results:
The size, cellularity of stromal fragments, and the proportion of spindle cells in the background are important features in such differentiation.
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Cytological pattern of cervical papanicolaou smear in eastern region of Saudi Arabia
Magdy Hassan Balaha, Mohammed Saleh Al Moghannum, Naema Al Ghowinem, Souad Al Omran
October-December 2011, 28(4):173-177
DOI
:10.4103/0970-9371.86343
PMID
:22090690
Background:
Cancer of the cervix has been considered as one of the preventable cancers. This study is the first published research addressing the screening of cancer of the cervix in the eastern region of Saudi Arabia.
Aim:
This study aims to detect the prevalence of abnormal epithelial changes and its types in the eastern region of Saudi Arabia.
Settings and Study Design:
A retrospective study was designed to evaluate all previously conducted cervical smears examined at a secondary care maternity hospital in Saudi Arabia, during the period from 2003 to 2010. During this period, a total of 1171 smears were reported.
Materials and Methods:
We analyzed the records of all patients who had undergone Papanicolaou (Pap) smear during this period. After data collection, all cases were recorded as per Bethesda nomenclature.
Results:
A total of 624 (53.3%) abnormal Pap smears were found, with only 58 cases reported to have squamous intraepithelial lesions (SIL). They represented 4.95% of total taken smears. A majority of the SIL diagnoses in our population were ASCUS, representing 60% of SIL cases. The prevalence of squamous cervical carcinoma was 0.34%.
Conclusion:
The study has shown a relatively high prevalence of epithelial abnormalities in cervical smears in the studied population. The squamous cell carcinoma represented a higher than the overall prevalence compared to World Health Organization (WHO) factsheets about Saudi Arabia. The mean age of epithelial abnormalities and squamous cell carcinoma was in the reproductive years.
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REVIEW ARTICLE
Intraoperative neurocytology of primary central nervous system neoplasia: A simplified and practical diagnostic approach
Suash Sharma, Prabal Deb
October-December 2011, 28(4):147-158
DOI
:10.4103/0970-9371.86339
PMID
:22090687
Intraoperative consultations may pose considerable diagnostic challenge to the neuropathologist in diagnosing primary and metastatic neoplasms of the central nervous system (CNS). Cytological preparations in the form of squash, touch, imprint or smears are few of the available modalities in addition to the frozen section (FS). Although the latter is superior in providing both histologic patterns and cytomorphologic details yet smears are of vital importance when tissue available is limited (stereotactic biopsy), scrutinisation of intercellular matrix (astrocytoma versus oligodendroglioma) and evaluation of discohesive cells (lymphoma, pituitary adenoma) and in inflammatory lesions. This review is intended to emphasize the value, applicability and limitations of neurocytology aiming to expedite the intraoperative smear-based diagnoses of CNS neoplasia as per the World Health Organization (WHO) classification. We recommend that whenever possible, both smears and FS should be examined concomitantly and in a correlative manner. In the unlikely event of a mismatch between the findings on smear and FS, intraoperative diagnosis is primarily based on FS, if adequate tissue is available. However, each case must be evaluated on its own merit and in difficult cases relevant differential diagnoses should be offered to facilitate surgical decisions and optimally triage patient management.
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ORIGINAL ARTICLES
Cytodiagnosis of thyroid lesions-usefulness and pitfalls: A study of 288 cases
M Guhamallick, S Sengupta, NK Bhattacharya, N Basu, S Roy, AK Ghosh, M Chowdhury
January-March 2008, 25(1):6-9
DOI
:10.4103/0970-9371.40650
Background:
Fine needle aspiration cytology (FNAC) of the thyroid gland has been widely and successfully utilized for diagnosis.
Aim:
Our aim was to demonstrate the effectiveness of this cheap and simple procedure for the diagnosis of different thyroid lesions, particularly, differentiation of malignant and nonmalignant lesions. In addition, we sought to highlight probable causes of error and possible remedies in the cases showing lack of correlation between cytological and histological diagnoses.
Materials and Methods:
A total of 288 cases of thyroid swellings were aspirated in our two-year study period. Cases were divided into four groups, namely, aspiration inadequate where diagnosis was not offered; a nonneoplastic group which included different goiters and thyroiditis; an indeterminate group which included cases showing features of follicular or Hurthle cell neoplasms, and a malignant group that included nonfollicular malignant tumors of the thyroid. Cases showing cytohistologic disparity were reevaluated.
Results:
Almost 14% of the cases could not be reported because of inadequate aspiration, however, an overall cytohistological correlation was achieved in 82.66% of all cases. Sensitivity and specificity for the diagnosis of malignancy were 92.7 and 98.2%, respectively. There were four false negative malignant cases with one false positive case and 13 cases failed to show any cytohistological correlation.
Conclusions:
FNAC is the single most important test for preoperative assessment of thyroid pathology if attention is paid to the clinical features and collection of samples from proper sites.
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Role of scrape cytology in ovarian neoplasms
Shalinee Rao, N Sadiya, Leena Dennis Joseph, S Rajendiran
January-March 2009, 26(1):26-29
DOI
:10.4103/0970-9371.54864
PMID
:21938145
Aim:
The present study was done to evaluate the role of scrape cytology in the diagnosis of ovarian neoplasm and its utilization for teaching pathology residents.
Materials and Methods:
This was a prospective study on 50 solid/solid-cystic ovarian neoplasms sent in 10% buffered formalin. Scrapings obtained from the fresh cut surface of tumors were smeared uniformly on to glass slides, immediately fixed in 95% ethyl alcohol and stained with hematoxylin and eosin stain.
Results:
The overall diagnostic accuracy of scrape cytology has been satisfactory with 92% of cases correlating with the final diagnosis. Characteristic cytological pattern was noted in various types of surface epithelial, sex cord stromal and germ cell tumors. The technique had limited value in mucinous tumors to distinguish borderline cases from invasive carcinoma. Two mucinous carcinomas were diagnosed as borderline mucinous tumor and two endometrioid carcinomas were misinterpreted as cystadenocarcinoma on scrape cytology. Formalin did not interfere or produce any remarkable changes in cytomorphology.
Conclusions:
Scrape cytology is a simple, rapid, accurate, inexpensive adjunctive cytodiagnostic technique and its routine utilization in ovarian lesions could aid in expanding the cytological knowledge of ovarian neoplasms.
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SYMPOSIUM
Cytology of soft tissue tumors: Benign soft tissue tumors including reactive, nonneoplastic lesions
Venkateswaran K Iyer
July-September 2008, 25(3):81-86
DOI
:10.4103/0970-9371.44034
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Online since 15
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April, 2008