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2007| April-June | Volume 24 | Issue 2
July 22, 2008
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Efficacy of broncho-alveolar lavage and bronchial brush cytology in diagnosing lung cancers
DS Gaur, NC Thapliyal, S Kishore, VP Pathak
April-June 2007, 24(2):73-77
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.
FNAC of salivary gland - a useful tool in preoperative diagnosis or a cytopathogist's riddle?
M Kotwal, S Gaikwad, R Patil, M Munshi, S Bobhate
April-June 2007, 24(2):85-88
Fine needle aspiration cytology (FNAC) of suspected salivary gland lesions has an established role in preoperative diagnosis and management of patients. However diverse morphological patterns and overlapping features make it a challenging job, to give a precise diagnosis, at times. The aim of the present study is to discuss the problems and pitfalls in FNAC of salivary gland lesions and try to find out possible solutions. From cytology records of last 18 months (January 2004 to June 2005), four problematic cases were picked up, out of total 101 aspirates of salivary gland lesions. Cytology diagnosis was pleomorphic adenoma in first three cases and low grade mucoepidermoid carcinoma in the fourth case. The histopathological diagnoses in these cases were low grade mucoepidermoid carcinoma, squamous cell carcinoma with fibromyxoid stroma, basal cell adenoma and benign lymphoepithelial cyst respectively. Cytology slides were reviewed. The problems in all these cases are discussed with possible solutions to solve the riddle. Certain guidelines can be practiced in order to avoid these pitfalls to a certain extent. MGG staining is a must in FNA of salivary gland lesions. Genuine problems do occur in typing of salivary gland tumours and it is prudent on occasions to limit the cytology report to differential diagnosis.
Cytology of renal angiomyolipoma with predominant epithelioid cell component - a report of two cases with review of literature
N Sood, R Batra
April-June 2007, 24(2):92-95
Renal Angiomyolipoma (AML) is a benign lesion with a variable admixture of fat cells, thick walled blood vessels, smooth muscle and polygonal epithelioid cells. The lesion can be diagnosed with certainty in the presence of all the components on fine needle aspiration, supported by CT findings. However the presence of predominant population of epithelioid cells with paucity or absence of other components can be particularly worrisome, especially if radiological findings are noncontributory. These large cells with low N:C ratio and frothy cytoplasm and anisonucleosis require detailed evaluation and careful search for typical background cytology. Two such cases of AML with a predominant population of epithelioid cells are being described with their cytological and histological findings with a review of literature to highlight the diagnostic dilemma and emphasize the utility of HMB-45 immunostaining in such cases.
Diagnostic value of image guided fine needle aspiration cytology in assessment of vertebral and paravertebral lesions
S Menon, N Gupta, R Srinivasan, K Mandeep, R Nijhawan, A Rajwanshi, N Khandelwal
April-June 2007, 24(2):79-81
Fine needle aspiration cytology (FNAC) of radiologically detected vertebral and paravertebral lesions is now used extensively for diagnosis and further management of patients. In this study, we report our experience with image guided FNAC diagnosis of vertebral and para-vertebral lesions in a total of 150 cases. Out of a total of 150 patients, 34 (22.7%) cases were positive for malignancy, 61 (40.7%) cases were benign non neoplastic lesions, 23 (15.3%) had inadequate/ unsatisfactory material for diagnosis, 31 (20.7%) had normal cellular elements of bone marrow and 1 (0.6%) case was diagnosed as a benign nerve sheath tumour. Radiologically guided FNAC is a simple, cost effective procedure in vertebral and paravertebral lesions.
Gastrointestinal stromal tumours - report of three cases and review of literature
A Deshpande, MM Munshi
April-June 2007, 24(2):96-100
Three cases of GIST were diagnosed on guided fine needle aspiration cytology. Two cases showed groups and whorls of benign spindle cells with elongated, blunt ended nuclei, which were diagnosed as GIST (probably benign). One case showed more obvious pleomorphism, round nuclei and binucleation. This was diagnosed as GIST (probably borderline/malignant). Although a tentative grading was communicated to the surgeon, it was made very clear that a confident grading cannot be given on cytology because this is based on size, presence of necrosis/haemorrhage and the mitotic count. Although a confident diagnosis of GIST can be made on cytology, we believe that grading should be left to histology.
A survey of practice patterns of fine needle aspiration among junior doctors in Lagos, Nigeria
SA Malami, B Ojo, M Nnoli, VI Onyiaorah, C Anunobi
April-June 2007, 24(2):67-72
Fine needle aspiration (FNA) cytology is a rapid and inexpensive screening test for cancer and its precursors but the technique is underutilized in Nigeria because clinicians are ignorant of its many advantages. A cross sectional descriptive study was undertaken using a pre-tested close and open-ended interview questionnaire administered on 44 junior doctors in the Lagos University Teaching Hospital (LUTH) a prominent training institution in Nigeria to highlight their general knowledge, perceptions and utilization of the technique. The response rate in this survey was 55 %. Awareness of the FNA among the respondents was high and knowledge of its principal indications, cost effectiveness and limitations was quite good. But there are important gaps in the other aspects of their knowledge of the technique which might explain why so many (50 per cent) had the wrong attitude to its adoption as a first line investigative procedure, particularly with respect to obvious misconceptions about its accuracy and safety. Significantly, many of the junior doctors were unaware of the places of imaging (50 %) and molecular studies (25 %) in routine FNA practice. In our opinion this study has highlighted the need for more physicians' training in FNA in Nigeria. Being a technique that is easily adapted to conditions in the developing countries, it is hoped that this simple test would be used more often in future for pre-operative diagnoses in this and other developing nations.
Comparison of unsatisfactory aspirates in fine needle aspiration performed by surgical medical officers and pathologists
G Kaur, S Sivakumar
April-June 2007, 24(2):82-84
The evaluation of fine-needle aspiration cytology (FNAC) is based on a satisfactory cell yield, which is highly operator-dependent. The aim of this study was to compare the proportion of unsatisfactory aspirates obtained by surgical medical officers and pathologists. FNAC case reports were retrospectively reviewed and cases grouped according to organ/site and person who performed the FNA procedure. An aspirate was deemed 'adequate' when a diagnostic report was issued; and 'unsatisfactory' when a report contained terms such as 'unsatisfactory sample' or 'inadequate cellularity for interpretation'. The results showed of a total of 1,248 FNAC reports reviewed, 610 (48.9%) aspirations were performed by medical officers and 638 (51.2%) by pathologists. The most common organs subjected to FNA were breast (68.9%), thyroid (17%), lymph node (9.3%) and others (salivary glands and soft tissue lumps) (4.8%). The overall proportion of unsatisfactory aspirates was 16.7%. Of aspirates performed by medical officers, 26.4% were unsatisfactory compared to 7.5% obtained by pathologists (P<0.001). Pathologists had significantly lower proportion of unsatisfactory aspirates in all organs compared to medical officers. Thyroid lesions had the highest number of unsatisfactory aspirates when performed by medical officers. Hands-on training in aspiration techniques for medical officers and the use of cytospin smears and cell block in bloody thyroid aspirates will be conducted.
Choroid plexus papilloma with cytologic differential diagnosis - a case report
I Pant, S Chaturvedi, V Suri, R Dua
April-June 2007, 24(2):89-91
The cytopathologic features of choroid plexus papilloma observed in a one year-old male child are reported and compared with other paediatric central nervous system neoplasms. The cytologic features of choroid plexus papilloma are similar to those of normal choroid plexus and may be difficult to distinguish from those of a well differentiated papillary ependymoma and other tumours with papillae formation. However, the salient cytologic features of choroid plexus papilloma include well defined papillary clusters, monolayered sheets and isolated scattered tumour cells, comprising of cuboidal cells with uniform round or oval nuclei, evenly dispersed chromatin and moderate amount of cytoplasm. The utility of crush cytology in the rapid diagnosis of central nervous system tumours along with the differential diagnoses are highlighted in this report.
Myeloma presenting as bilateral pleural effusion - a cytological diagnosis
K Dhingra, R Sachdev, N Singhal, S Nigam, S Jain
April-June 2007, 24(2):101-102
Multiple myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis. A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. Chest radiograph showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included myelomatous effusion and non-Hodgkin's lymphoma (immunoblastic type) deposit. Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (plasmablastic type). Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells in body fluids irrespective of age.
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