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Metaplasia is a reversible reprogramming of stem cells of the epithelium. Usually, squamous metaplasia is observed in the endocervix. However, less frequently, tubal metaplasia may develop, replacing nonciliated columnar cells by ciliated columnar cells, similar to fallopian tube epithelium. Here we present a case of tubal metaplasia of the endocervical canal. A 40 year-old female presented with postcoital bleeding; her uterus was retroverted, normal-sized and the fornices were free. Erosion was seen around the external os with ulceration. The clinical diagnosis was chronic cervicitis. Cytobrush sampling showed abundant endocervical columnar cells. A distinct morphological variation showing apical ciliary plates with distinct cilia were noticed in many columnar cells. Mucoid, neutrophil-rich secretions were seen in the background but no malignant cells were seen, resulting in a diagnosis of tubal metaplasia of the endocervical epithelium. There was no Trichomonas vaginalis infection. Tubal metaplasia should be identified as a unique benign identity and should not be confused with early endocervical glandular neoplasia of the cervix. Cytobrush technique for endocervical smears helps detect such uncommon metaplastic changes.

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Pleomorphic lobular carcinoma of the breast has been identified as a histological variant of infiltrating lobular carcinoma (ILC) with poor prognosis. Thus, cytological recognition of this tumour is important. It is characterized by pleomorphism to a degree that contrasts with the cytologic uniformity of classic ILC. Due to this feature it is often misinterpreted as infiltrating ductal carcinoma and diagnosed only on appreciating the Indian file and targetoid pattern of lobular carcinomas on histology. We report three cases with this unusual tumour that can present a diagnostic dilemma on cytology.

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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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Background: Cervical acid phosphatase-Papanicolaou (CAP-PAP) test has recently been described for detection of acid phosphatase enzyme in abnormal squamous cells, and has been proposed as a biomarker-based technology for the screening of cervical cancer. Materials and Methods: Eighty-one consecutive cervical smears were subjected to routine Papanicolaou (Pap) staining as well as CAP-PAP, which combined cytochemical staining for acid phosphatase with modified Pap stain. Statistical evaluation of its utility was examined. Results: Of 81 smears, 16 (19.75%) showed the presence of mature squamous cells with acid phosphatase by CAP-PAP technique and were considered positive. Of these 16, atypical squamous cells of undetermined significance (ASCUS) or above were initially diagnosed in five of the corresponding routine Pap smears. After re-evaluation with CAP-PAP, eight of the routine Pap smears were considered to have ASCUS or above. Of these eight, three were reported as low-grade squamous intraepithelial lesions and five as ASCUS on conventional Pap smears. The remaining 8/16 CAP-PAP-positive cases were negative for atypical squamous cells on the corresponding Pap smears. None of the CAP-PAP-negative smears were positive on routine Pap smear screening. Conclusions: This study highlights the efficacy of CAP-PAP in quality assurance of cervical smear screening. It is also an inexpensive method for segregating smears for subsequent re-screening. In the absence of trained cytologists in peripheral laboratories, this technique can be adopted for identifying smears that would require proper evaluation.

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A 35 year-old male presented with multiple asymptomatic, tense, cystic to firm, skin-colored nodules within the scrotal skin with a provisional clinical diagnosis of a sebaceous cysts of the scrotum. Fine needle aspiration cytology (FNAC) was performed and a diagnosis of idiopathic calcinosis of the scrotum was suggested as no epithelial cells were found around amorphous, basophilic, calcified material. Histopathological examination confirmed the diagnosis. We report this case for its rarity.

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Malignant peripheral nerve sheath tumors (MPNST) are rare malignant mesenchymal neoplasms of neural origin. Malignant peripheral nerve sheath tumors arising in a cranial nerve are rare with only a few cases being reported in literature. An MPNST with rhabdomyosarcomatous differentiation is also known as malignant triton tumor (MTT). MTT has a worse prognosis than the classic MPNST. The cytomorphological patterns of these tumors are insufficiently documented in literature. We present here the cytohistological features of an MPNST with focal rhabdomyomatous differentiation arising in the trigeminal nerve, which was confirmed by immunohistochemistry.

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Of all the cases investigated for suspected lung cancer between June 1999 and June 2003, 196 cases were selected where flexible bronchoscopic samples of broncho-alveolar lavage (BAL) and bronchial brush (BB) cytology as well as bronchial biopsy were taken and processed as per standard procedures of cytology and histology. The aim of this study was to compare the diagnostic efficacy of BAL and BB cytology in diagnosing lung cancer, taking bronchial biopsy as the 'Gold Standard' diagnostic test. Sensitivity of BB was 87.3%; while that of BAL was 39.4%. Specificity of BB and BAL was 97.6% and 89.6%, respectively. BB was better than BAL in morphological typing of lung cancers. We conclude that bronchial brushing is a much superior technique in the diagnosis and morphological typing of lung cancers.

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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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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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This study aimed to assess the role of pleural fluid analysis in diagnosing pleural malignancy. Thoracentesis and closed needle biopsy of parietal pleura, using Cope's needle, were performed in 45 cases of pleural effusion coming to Department of Pulmonary Medicine. Samples were processed and studied as per standard methods. The male to female ratio was 4.6:1. Age range was 18-74 years. Two pleural effusions were transudates. Amongst the 43 exudates, 17 cases were malignant on pleural fluid analysis. Cyto­histological correlation was 68.4% for malignancy. Adenocarcinoma was the most common malignancy. Pleural fluid showed good sensitivity, specificity and accuracy. In developing countries, where investigations and health facilities are inadequate and cost of treatment is un-affordable, careful analysis of pleural fluid still remains a very convenient, low-cost and safe investigation that helps in diagnosing cases of malignant pleural effusion. Its combination with pleural closed needle biopsy can further enhance its usefulness in diagnosing pleural malignant lesions.

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Neoplastic meningitis is seen in five to ten percent of patients with solid tumors and is characterized by multifocal neurological signs and symptoms. The diagnosis is established by imaging, cerebrospinal fluid (CSF) cytology, and radioisotope CSF flow studies. Gastric adenocarcinoma is a rare cause of neoplastic meningitis. We review here CSF cytology results from our Oncology center obtained over two years and report three cases of gastric adenocarcinoma with cytologically positive CSF.

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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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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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Background: Fine needle aspiration (FNA) is said to have greater diagnostic accuracy in Hodgkin lymphoma (HL) as compared to non-Hodgkin lymphoma (NHL). In spite of this, HL accounts for most of the false negative cytodiagnoses among lymphomas. Aims: To evaluate the accuracy of FNA in HL and to identify the diagnostic pitfalls. Materials and Methods: A retrospective study of 18 biopsy-proven cases of HL that had a preceding FNA from the same lymph node. Results: Nine out of eighteen cases were labeled HL, which were diagnosed on the basis of atypical mononuclear cells in preference to classic Reed-Sternberg (RS) cells. Three cases were termed lymphoproliferative, which showed the presence of only atypical mononuclear cells with eosinophilic nucleoli. Six cases were false negative cases. Four of these were hypocellular with biopsy in two cases displaying marked fibrosis. The remaining two cases were labeled reactive and review also showed no additional findings. Conclusions: Presence of atypical mononuclear cells in cytology should prompt a cautious search as classic RS cells may not be a prominent feature in aspirates of HL. Focal involvement and abundance of reactive lymphoid cells may lead to false negative diagnoses. Hypocellularity of aspirates disproportionate to lymph node size warrant caution. Overall, FNA is useful in the diagnosis of HL, provided one is aware of the pitfalls. It is particularly valuable in screening cases that will require biopsy.

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Background: Evaluation of cytologic features is indispensable in the preoperative diagnosis and grading of infiltrating ductal breast carcinoma (CA) in fine-needle aspiration cytology (FNAC) material and this method can also provide additional information regarding intrinsic features of the tumor as well as its prognosis. Aim: This study has been done to evaluate comparatively the cytologic and histomorphologic grading of infiltrating ductal carcinoma of breast with specific reference to lymph node metastasis and its role in prognostication. Materials and Methods: Forty three patients who underwent FNAC and mastectomy for infiltrating ductal carcinoma were cytologically and histologically graded (employing Robinson's cytologic grading system and Elston's modification of Bloom-Richardson system, respectively). Statistical analysis was done employing 'z' test and c² test to compare the two grading system and to examine the degree of correlation between the cytologic and histologic grades. Multiple regression analysis was done to assess the significance of every cytologic and histologic parameter. All 43 cases, graded cyto-histologically were also evaluated for presence or absence of metastasis to the regional lymph nodes employing c² test. Results: With histologic grade taken as the standard, cytology was found to be fairly comparable, for grading breast carcinoma (overall sensitivity 89.1%, specificity 100%). Further comparison of the two grading systems by Z-test showed that difference between the cytologic and histologic grading was insignificant in all the three grade (p > 0.05). Of the six parameters studied, cell dissociation, nucleoli and chromatin pattern were the most influential features (p < 0.001). The statistically significant difference (p < 0.001) was found in incidences of axillary lymph node metastatic rate in three cytologic grades (15.4% in grade I vs. 83.3% in grade III) as well. Conclusions: Apart from being simple and noninvasive, cytologic grading is comparable to histologic grading and might provide relevant information on the aggressiveness of invasive ductal carcinoma of breast and could be a useful parameter to take into consideration when selecting mode of therapy and to predict tumor behavior.

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The study was undertaken to evaluate liquid based cytology (Pap spin) and to compare the sensitivity of Pap spin with conventional Pap smear. Pap smears were taken from 160 patients with gynaecologic complaints with Ayre's spatula and endocervical cytobrush and slides prepared. The residual material on both the spatula and cytobrush were rinsed in Pap spin collection fluid and centrifuged. Direct smears were prepared from the cell button, fixed and stained by Papanicolaou stain. Colposcopy was performed in patients with abnormal smears and biopsy was performed in suspected malignant or dysplastic cases. LSIL and HSIL was diagnosed in 27 (64.4%) cases, mostly between 21-40 years, Commonest presenting complaint was discharge per vaginum seen in 68 (42.5%) cases. Cytological abnormality was found in 42 cases (26.2%) by Pap spin method, whereas conventional Pap smear detected abnormality in only 24 cases (15%). 133 cases (83.1%) were satisfactory for evaluation on Pap spin and 51 cases (31.9%) on conventional Pap smear. The commonest atypical finding on colposcopy was acetowhite area in 14 cases (31.1%). Sensitivity of Pap spin and conventional Pap smear was 97.6% and 53.7% respectively and specificity was 50% in each. Pap spin is strongly advocated in the best interest of public health as it improves the sample quality and reduces the likelihood of false negative results.

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Background and Aims: Fine needle aspiration cytology (FNAC) is a relatively new technique for the diagnosis of pediatric tumors. Most of the studies conducted so far have dealt only with malignant neoplasms or neoplasms of a particular organ/organ system in the pediatric population. Our work included a comprehensive study of both benign and malignant tumors in children younger than 15 years of age to correlate their clinical, cytological, and histological findings and to evaluate the effectiveness of FNAC in their diagnosis. Materials and Methods: We studied 588 cases over a period of ten years. Data was collected retrospectively as well as prospectively, and included all patients younger than 15 years of age, who presented with tumors or associated symptoms. Clinical, cytological, and histopathological correlations were done. Results: Benign soft tissue tumors formed the largest group among all pediatric tumors (41.5%). Lymphomas were the most common (25.1%) of all malignant tumors, followed closely by small round cell tumors (SRCTs, 21.3%). FNAC was performed in 342 (55.1%) cases, cyto-histological correlation was possible in 226 (38.4%) cases; and a concordant diagnosis was seen in 218 (37.1%) cases, giving an overall diagnostic accuracy of 96.46% with FNAC. Occasional rare cases like Dabska's tumor and intraabdominal desmoplastic small round cell tumor could also be diagnosed by FNAC. Conclusions: We conclude that FNAC is an effective method for the evaluation and screening of pediatric masses, as well as for follow-up of patients with a history of malignancy.

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Background: Long-term use of antiglaucoma drugs induces adverse changes on the conjunctival surface. Aim: To evaluate the cytological changes in the conjunctival scrape smears of patients receiving long-term antiglaucoma medication and their histopathological correlation. Materials and Methods: Conjunctival scrape smears were taken from the eyes of patients on long-term antiglaucoma therapy for over three months (n = 75), patients taking antiglaucoma medication for less than three months (n = 100) and from glaucomatous patients in whom trabeculectomy was done as a primary procedure. Inflammatory cell counts, fibroblasts, and the degree of metaplasia were then evaluated both cytologically and histologically. The t-test was used to determine the predictive values of these parameters for the surgical outcome of trabeculectomies. Results: Long-term use of antiglaucoma therapy leads to a higher stage of metaplasia with an increase in the number of fibroblasts, subepithelial collagen deposition, and inflammatory infiltrate within the substantia propria of the conjunctiva. Conclusions: Long-term antiglaucoma medications induce a significant degree of metaplasia in the conjunctival surface that adversely affects the outcome of filtration surgery.

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Human Papilloma virus (HPV) infection of uterine cervix is known to be a very important risk factor for the development of cervical intraepithelial neoplasia and invasive cancer. This infection, that affects partners, is presently being investigated mostly in females. This study utilized a simple technique of urethral cytology and penioscopy to screen 38 male consorts of women with HPV infection of uterine cervix. A simple naked eye examination and examination under magnification of the male genitalia i.e."Penioscopy" was performed. A cytologic smear was obtained from the urethra using a cytobrush. Five percent acetic acid was then applied and acetowhite areas, if any, were noted. Smears were studied for features indicative of HPV infection. 10 male consorts, all of whom were asymptomatic, showed evidence of HPV infection.

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