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2008| October-December | Volume 25 | Issue 4
May 4, 2009
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Cells in pleural fluid and their value in differential diagnosis
Rashmi Kushwaha, P Shashikala, S Hiremath, HG Basavaraj
October-December 2008, 25(4):138-143
: Both non-malignant and malignant causes of effusion can be identified by the relatively non-invasive technique of pleural fluid cytology. With this basis the present study on cytology of pleural fluids was taken up. The diagnostic significance of the cytologic study of the fluid may be attributable to the fact that the cell population present in the sediment is representative of a much larger surface area than that obtained by needle biopsy.
Materials and Methods
: One hundred samples of pleural fluid were examined for total cell count, cell type and cellular features. They were also subjected to biochemical study to find out the level of protein, glucose and chloride.
: A total of 82% samples were exudative and 18% were transudative. Total leukocyte count (TLC) was less than 1000 cells/cu.mm in most (88.89%) of transudative effusions. Overall 52.44% of exudative effusions had TLC greater than 1000 cells/cu.mm. It was noted that 96.88% of tuberculous effusions had more than 50% lymphocytes, 81.25% had protein greater than 5 gm/dl and 90.63% had glucose greater than 60 mg/dl. Approximately 28% of pleural effusions were positive for malignant cells. Most (82%) of malignant effusions were exudative. The primary site could be assessed by cytological examination in 57.14% of malignant effusions.
The most useful test in establishing the diagnosis of pleural effusion is pleural fluid cytology and pleural fluid cell count. Cytologic study of pleural fluid is a complete diagnostic modality which aims at pointing out the etiology of effusion as well as, in certain cases, a means of prognostication of disease process.
Diagnostic problems in fine needle aspiration cytology of fat necrosis within a subcutaneous lipoma
Vikas S Kavishwar, Asha B Rupani, Anjali D Amarapurkar, Vyankatesh Anchinmane
October-December 2008, 25(4):150-152
Fat necrosis in subcutaneous lipomas is very unusual and has been reported only occasionally. Literature regarding fine needle aspiration cytology of such a lesion is lacking although fat necrosis is well described in the breast. We came across a case of a large subcutaneous lipoma in the anterior abdominal wall with a well encapsulated area of fat necrosis. The aspiration smears showed an unusual picture which was misinterpreted as the fragments of the hydatid cyst wall. They were actually enlarged, nonnucleate, single adipocytes showing laminations, along with calcification and paucity of inflammation. Histopathology confirmed the diagnosis of fat necrosis within the lipoma. Such lesions can be mistaken on radiology for malignancy.
Pitfalls in the cytodiagnosis of metastatic squamous cell carcinoma in the head and neck: A retrospective study
Karabi Konar, Sulekha Ghosh, Tapan Ghosh, Subodh Bhattacharya, Saurabh Sanyal
October-December 2008, 25(4):119-122
Lateral neck swelling in an adult is a common presentation for primary and secondary malignant lesions. Metastasis from squamous cell carcinoma often leads to various secondary changes in the lymph nodes, which makes their diagnosis on cytology a difficult task. Sometimes, the primary sites remain occult and any false negative cytological diagnosis becomes a misleading factor.
Our aim was to evaluate the efficacy of fine needle aspiration cytology (FNAC) in diagnosing metastasic squamous cell carcinoma in the head and neck, and to highlight the precautions that can reduce the rate of false negative diagnosis.
Materials and Methods:
Two thousand five hundred and twelve patients in an age range of 18 to 80 years and presenting with a solitary lateral swelling of the neck were selected for this study.
Three hundred and seventy positive and 45 suspicious cases of metastatic squamous cell carcinoma were detected by FNAC; there were 15 false negative cases. All of them were associated with cystic change, abscess, or necrosis. The primary sites for carcinoma were the tonsil, tongue, pharynx, and larynx. No primary site could be detected in three cases. Histopathological confirmation was done in all the cases. The specificity and sensitivity of FNAC in the detection of positive cases of metastatic squamous cell carcinoma were 96.05 and 96.5% respectively.
Any lateral neck swelling in adult patients that is associated with cystic change, abscess, or necrosis on FNAC should be carefully searched for malignant cells. Clinical re-evaluation and image guided surgical biopsy should supplement FNAC in suspicious cases. In spite of the possible limitation of a false negative diagnosis, FNAC remains a useful tool in diagnosing metastasis with good certainty.
Cytological assessment of endometrial washings obtained with an insemination cannula and its histological correlation
Reeni Malik, Renu Agarwal, Puneet Tandon
October-December 2008, 25(4):128-132
Endometrial cytopathology is a powerful tool for the detection of a wide variety of benign atypias, inflammatory changes, and infectious organisms. It is also helpful for the cytohormonal evaluation of patients and the detection of endometrial malignancies.
The present study was carried out to assess the sensitivity and specificity of endometrial cytology performed by using an insemination cannula.
Materials and Methods:
Endometrial aspiration using an insemination cannula was done in 60 cases who presented with dysuterine bleed, infertility, or postmenopausal bleed. The cytological evaluation of endometrial smears was correlated with histopathological findings with reference to cyclic endometrium, atypical hyperplasia, and endometrial malignancies.
There were 35 patients in the reproductive and 25 in the menopausal age groups. The sample was inadequate in four cases but there was an overall 100% correlation between cytological and histological findings of cyclic endometrium, atypical hyperplasia, and endometrial malignancy. The sensitivity and specificity of endometrial aspiration was 83.3 and 95.4% respectively, with two false negative and false positive cases.
Endometrial aspiration cytology was found to be a safe outpatient procedure in the diagnosis of normal and abnormal endometrium for patients of all ages.The present study emphasizes the need for endometrial screening in postmenopausal patients to enable the detection of endometrial malignancies at an early stage.
Cytohistological study of eyelid lesions and pitfalls in fine needle aspiration cytology
Santosh Kumar Mondal, Tapan Kumar Dutta
October-December 2008, 25(4):133-137
: The purpose of the study was to evaluate different eyelid lesions appearing as a swelling or mass, using fine needle aspiration cytology (FNAC), to conduct a cytological diagnosis of these lesions with subsequent histopathological correlation, and to identify the problems faced during microscopical examination of the smears.
Materials and Methods
: Fine needle aspirates from 80 eyelid swellings and histopathological correlation in 62 cases were studied.
Forty eight cases of benign and 32 cases of malignant lesions were diagnosed by FNAC. The five leading benign lesions were chalazions (12 cases, 15%), epithelial cysts (eight cases, 10%), chronic nonspecific inflammation (six cases, 7.5%), seborrheic keratosis (five cases, 6.25%) and benign adnexal adenoma (four cases, 5%). The most common malignant lesion was basal cell carcinoma (12 cases, 15%) followed by sebaceous gland carcinoma (nine cases, 11.25%) and squamous cell carcinoma (eight cases, 10%).
Histopathological correlation showed that the accuracy of fine needle aspiration cytology in making diagnosis was 83.87%. Incidence of basal cell carcinoma in the study was lower, compared to most western studies. Therefore, there may be a racial and geographical variation.
Radiologically guided fine needle aspiration cytology of retroperitoneal and spinal lesions
Mehar Aziz, Nishat Afroz, Eram Kahkashan, Ibne Ahmad, Tariq Mansoor
October-December 2008, 25(4):123-127
This study was undertaken to assess the role of image-guided, fine needle aspiration cytology (FNAC) in the diagnosis of retroperitoneal and spinal lesions.
Materials and Methods:
Over a period of one year, ultrasonography and computerized tomography-guided FNAC was performed in 55 cases who had presented clinically with signs and symptoms related to the retroperitoneum and spine. Histopathological confirmation was available in 27 out of 55 cases.
Of the 55 cases, 39 were males and 16 were females. Malignant and benign lesions accounted for 58.2 and 29.1% respectively. Among the cases on whom radiologically guided FNAC was performed, the spine contributed the largest proportion of cases (32.7%), followed by renal lesions (20%). Among the malignant lesions, renal cell carcinoma was the most commonly found malignancy, followed by metastasis to the spine. In the benign and inflammatory category, tuberculosis of the spine and the lymph nodes was the most common lesion accounting for 68.7% of all cases. On correlating clinical, radiological, and cytologic features, the sensitivity, specificity, and overall accuracy of guided FNAC obtained in this study were 97.1, 84.2, and 92.4% respectively.
Radiologically guided FNAC is a fairly accurate and safe procedure in diagnosing the most difficult cases in the region of the retroperitoneum and the spine.
Cutaneous metastasis in renal cell carcinoma
Shamshad Ahmad, Uzma Zafar, Farhan A Siddiqui, Kafil Akhtar
October-December 2008, 25(4):157-158
A case of renal cell carcinoma (RCC) occurring in a 65 year-old male presenting primarily as cutaneous metastasis to the chest, is being reported for its unusual presentation in the form of a skin nodule, even before the development of any urological presentation. RCC had metastasised to the liver as well. This case emphasises the importance of looking for a primary renal cancer in cutaneous metastasis cases as most of these patients have recurrent or multifocal metastatic disease.
Fine needle aspiration diagnosis of cryptococcal lymphadenitis: A window of opportunity
S Suchitha, CS Sheeladevi, R Sunila, GV Manjunath
October-December 2008, 25(4):147-149
Cryptococcal meningitis is the most common, life-threatening, opportunistic, fungal disease in human immunodeficiency virus (HIV)-infected individuals. An expeditious diagnosis is of utmost importance because once a cryptococcal infection disseminates, it becomes life-threatening. Pulmonary, intestinal, bone marrow, and retinal involvement have been described. There are very few reports, however, of lymphadenopathy along with cryptococcal meningitis. We report here a case of cryptococcal meningitis with lymphadenitis, which was diagnosed by fine needle aspiration cytology of the involved lymph nodes.
Primary pulmonary adenoid cystic carcinoma diagnosed by transthoracic fine needle aspiration cytology
Paras Nuwal, Ramakant Dixit, Sidharth Sharma
October-December 2008, 25(4):144-146
Adenoid cystic carcinoma (ACC) is an uncommon tumor that very rarely affects the lower respiratory tract and lung parenchyma. Fine needle aspiration cytology (FNAC) of primary pulmonary ACC has been rarely described. We report here a 32 year-old female with peripheral ACC, diagnosed by percutaneous transthoracic FNAC. The cytological diagnosis was further confirmed by histological examination of the biopsy specimen.
Solitary eosinophilic granuloma of the ulna: Diagnosis on fine needle aspiration cytology
Anshu Jain, Kiran Alam, Veena Maheshwari, Vivek Jain, Roobina Khan
October-December 2008, 25(4):153-156
Solitary eosinophilic granuloma is a part of the spectrum of Langerhans cell histiocytoses (LCH) which are rare diseases with varied clinical presentations. They comprise of three major overlapping syndromes: solitary eosinophilic granuloma (unifocal disease), Hand-Schueller-Christian disease (multifocal, unisystem), and Letterer-Siwe disease (multifocal, multisystem). A case of solitary eosinophilic granuloma of the ulna is presented here for its relatively uncommon incidence and the difficulty in making an accurate diagnosis based on the radiological picture alone. We hereby, emphasize the importance of a quick and reliable diagnosis based on fine needle aspiration cytology, and the need to consider the possibility of LCH in the differential diagnoses of a slide showing a large number of histiocytes and eosinophils, as in tuberculosis, Hodgkin's disease, and other primary and metastatic bony lesions. Characteristic nuclear grooves and a large number of eosinophils help in clinching the cytological diagnosis.
LETTERS TO EDITOR
Adenoid cystic carcinoma: A rare presentation as a nasal and hard palate mass
Richa Pandey, PK Singh, Lubna Khan
October-December 2008, 25(4):159-160
Cytodiagnosis of tumoral calcinosis
Subhashish Das, R Kalyani, ML Harendra Kumar
October-December 2008, 25(4):160-161
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Indian Academy of Cytologists
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