Journal of Cytology
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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  
  27,442 901 6
ORIGINAL ARTICLES
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
DOI:10.4103/0970-9371.50799  
Background : 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. Results : 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. Conclusions: 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.
  23,011 1,174 -
SYMPOSIUM
Cytology of soft tissue tumors: Malignant spindle cell tumors
Aruna Prayaga
July-September 2008, 25(3):87-88
DOI:10.4103/0970-9371.44036  
  22,800 781 1
CASE REPORTS
Tubal metaplasia of the endocervix
Dushyant Singh Gaur, Sanjeev Kishore, Anuradha Kusum, Neena Chauhan, Savita Bansal, Avneet Boparai
January-March 2008, 25(1):33-35
DOI:10.4103/0970-9371.40657  
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.
  20,945 479 1
ORIGINAL ARTICLES
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.
  10,347 1,158 7
SYMPOSIUM
Cytology of soft tissue tumors: Pleomorphic sarcoma
Manjula Jain, Priya Malhan
July-September 2008, 25(3):93-96
DOI:10.4103/0970-9371.44040  
  10,850 503 3
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.
  9,656 1,254 10
CASE REPORTS
Pleomorphic lobular carcinoma of the breast - a diagnostic dilemma
H Kini, R Pai, AR Rau, FD Lobo, AJ Augustine, BS Ramesh
October-December 2007, 24(4):193-195
DOI:10.4103/0970-9371.41894  
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.
  10,519 311 1
ORIGINAL ARTICLES
Cervical acid phosphatase detection: A guide to abnormal cells in cytology smear screening for cervical cancer
Prabal Deb, Venkateswaran K Iyer, Neerja Bhatla, O Markovic, Kusum Verma
January-March 2008, 25(1):1-5
DOI:10.4103/0970-9371.40649  
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.
  8,233 689 1
Pleural fluid analysis - role in diagnosing pleural malignancy
DS Gaur, N Chauhan, A Kusum, M Harsh, M Talekar, S Kishore, VP Pathak
October-December 2007, 24(4):183-188
DOI:10.4103/0970-9371.41891  
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.
  8,200 621 1
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.
  8,092 617 -
Comparative evaluation of six cytological grading systems in breast carcinoma
Kaushik Saha, Gargi Raychaudhuri, Bitan Kumar Chattopadhyay, Indranil Das
April-June 2013, 30(2):87-93
DOI:10.4103/0970-9371.112647  PMID:23833396
Background: Cytological grading is a useful tool for selection of therapy and prognosis in breast carcinoma. Despite having many cytological grading systems, there is still no agreement among pathologists to accept one of them as a gold standard. Aim: This study was undertaken to evaluate six such three-tier cytological grading systems to determine which system corresponds best to histological grading done by Nottingham modification of Scarff Bloom Richardson (SBR)'s method. Materials and Methods: In a double-blind study, preoperative cytological grades obtained by six systems on fine-needle aspiration cytology (FNAC) smears were compared by testing concordance, association and correlation with histological grade derived postoperatively by the SBR's method in 57 patients of breast carcinoma. Bivariate correlation studies and multiple linear regressions were done to assess the significance of the different cytological parameters to predict final cytological grades. Results: Robinson's system demonstrated the best correlation (ρ = 0.799; P = 0.000 and τ = 0.765; P = 0.000), maximum percent agreement (77.19%) and a substantial kappa value of agreement (κ = 0.62) with the SBR's grading system. All the six cytological grading systems correlated with histological grading strongly and positively. In multiple regression analysis, all of the cytological parameters of Robinson's system except cell size and nucleoli had significance in predicting the final cytological grade. Conclusions: Robinson's grading system is simple, more objective and reproducible, and demonstrated the best concordance with histological grading. So, Robinson's system should be used routinely for breast carcinoma aspirates.
  7,215 1,300 1
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.
  7,100 901 7
CASE REPORTS
Idiopathic calcinosis of scrotum: Cytological diagnosis of a case
Rana K Sherwani, Bharat Kumar Varshney, Veena Maheshwari, Khaliqur Rahman, MA Khan
January-March 2008, 25(1):23-24
DOI:10.4103/0970-9371.40654  
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.
  7,525 275 -
ORIGINAL ARTICLES
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.
  6,793 785 2
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 χ2 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.
  6,597 825 5
Fine needle aspiration cytology of epididymal nodules
Vinaya B Shah, Tanuja M Shet, Shilpa K Lad
July-September 2011, 28(3):103-107
DOI:10.4103/0970-9371.83463  PMID:21897542
Background: The incidence of non neoplastic lesions are much more common in epididymis. Clinically, epididymal nodules are easily accessible to fine needle aspiration cytology (FNAC) procedure. There are very few literature reports documenting the role of cytology in evaluation of epididymal nodules. Thus, we studied patients presenting with palpable epididymis nodules in the out patient department (OPD) from a tertiary care general hospital. Aim: This study is aimed to put forth the diagnostic utility of FNAC in palpable lesions of epididymis. Materials and Methods: A total of 40 palpable epididymal nodules were aspirated as a routine OPD procedure as part of this study. Smears were fixed in isopropyl alcohol and air dried. In all the cases, wet fixed papanicoloau stained and air dried giemsa stained smears were studied. Zeihl Neelsen stain was performed in cases which yielded caseous aspirate. Results: Except for two cases of adenomatoid tumor of epididymis all other lesions were nonneoplastic and included 14 cases (35%) of tuberculous granulomatous inflammation, 10 (25%) cystic nodules (9 spermatoceles and 1 encysted hydrocele), 5 (12.5%) of nonspecific inflammations, 3 (7.5%) filarial infection, 3 (7.5%) sperm granulomas and 3 (7.5%) adenomatous hyperplasia of rete testes. Except for the two tumors, one adenomatous hyperplasia and one tuberculous lesion, no other lesion was excised. Follow up and response to therapy was available in 78% patients and resolution indicated appropriateness of the diagnosis. Conclusions: Thus, as most of the lesions in epididymis are non neoplastic responding to medical line of treatment and FNAC served to aid diagnosis of non specific inflammation and avoid surgical excision in most cases.
  6,707 304 1
CASE REPORTS
Squash preparation of a malignant triton tumor in a rare location
Sandhya Sundaram, D Prathiba, S Rajendiran, Shalinee Rao, K Ganesh
January-March 2008, 25(1):28-32
DOI:10.4103/0970-9371.40656  
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.
  6,738 247 -
ORIGINAL ARTICLES
Image-guided fine-needle aspiration cytology of ovarian tumors: An assessment of diagnostic efficacy
Ghazala Mehdi, Veena Maheshwari, Sheerin Afzal, Hena A Ansari, Maryem Ansari
July-September 2010, 27(3):91-95
DOI:10.4103/0970-9371.71872  PMID:21187883
Background : Image-guided fine-needle aspiration cytology (FNAC) of ovarian lumps is being increasingly used for the successful diagnosis of ovarian tumors, although borderline cases may be difficult to diagnose by this method. Aim : To demonstrate the efficacy of image-guided FNAC in diagnosing ovarian tumors (benign and malignant) and to evaluate the usefulness of cytology as a mode of easy and rapid diagnosis of ovarian lumps. Materials and Methods : The study was conducted on 42 female patients. Clinical evaluation and relevant investigations were carried out. Diagnosis was established by FNAC performed under image guidance (ultrasonography/computed tomography). The cytological diagnosis was confirmed by histopathological examination. Results : Cytological diagnosis was rendered on all the 42 ovarian lesions, with a correct diagnosis in 34 cases, resulting in a diagnostic accuracy of 80.9%. Most of the cases with discordant diagnoses were surface epithelial tumors of low malignant potential and required histopathological examination for a final diagnosis. Conclusions : Image-guided FNAC is an inexpensive, rapid and fairly accurate procedure for the diagnosis of ovarian lesions. It provides a safe alternative to the more expensive, time consuming and cumbersome surgical route to diagnosis.
  6,614 329 1
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.
  6,145 709 6
Fine needle aspiration cytology in the diagnosis of Hodgkin lymphoma: Hits and misses
TR Rashmi Kumari, T Rajalakshmi
January-March 2008, 25(1):10-12
DOI:10.4103/0970-9371.40651  
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.
  6,132 579 2
CASE REPORTS
Cytological diagnosis of acanthomatous ameloblastoma
Vaishali A Walke, Maitreyee M Munshi, Wamanrao K Raut, Sudhakar K Bobahate
April-June 2008, 25(2):62-64
DOI:10.4103/0970-9371.42447  
Ameloblastomas show wide morphological spectra and may pose diagnostic difficulties. Of the many types encountered, acanthomatous ameloblastoma is a rare variant that possesses distinctive features. To the best of our knowledge, there have been no previous reports on the cytology of acanthomatous ameloblastoma (AA). An elderly male presented with a radiolucent jaw swelling. Cytology smears showed combinations of basaloid cells with peripheral palisading, stellate cells as well as squamous cells in groups and in isolation. A diagnosis of acanthomatous ameloblastoma was made and subsequently confirmed on histology. Although AA is a rare jaw tumor, it possesses distinctive cytological features that permit confident preoperative cytodiagnosis.
  6,163 456 2
ORIGINAL ARTICLES
The integration of HR-HPV increases the expression of cyclins A and E in cytologies with and without low-grade lesions
MI Zubillaga-Guerrero, B Illades-Aguiar, MA Leyva-Vazquez, E Flores-Alfaro, E Castañeda-Saucedo, JF Muñoz-Valle, LC Alarcón-Romero
January-March 2013, 30(1):1-7
PMID:23661932
Background: Cyclin-A and cyclin-E are regulators of G1-S phase of normal cell cycle. Integration of human papilloma virus high-risk (HR-HPV) could alter this mechanism, and its overexpression has been associated with poor prognosis in cervical cancer. Aim: To determine the expression of cyclin-A and cyclin-E, types of HR-HPV and physical state of DNA in cytologies with the diagnosis of low-grade squamous intraepithelial lesion (LSIL). Materials and Methods: 115 cytological specimens in liquid base (liquid-PREP ) were analyzed. 25 specimens were with no signs of SIL (NSIL) and without HPV; 30 with NSIL with low-risk HPV (LR-HPV); 30 with NSIL with HR-HPV; and 30 with both LSIL and HR-HPV. The expression of cyclins was evaluated by immunocytochemistry; and the detection of viral DNA was done by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLPs) for genotyping or sequencing of HPV. The physical state of HPV was evaluated by in situ hybridization with amplification with tyramide. Results: In the cytologies NSIL with LR-HPV, the expression of cyclin-A and cyclin-E was found respectively in 23.3% and 33.3% of the specimens. Among the specimens of NSIL with HR-HPV, 33.3% expressed cyclin-A and 40% cyclin-E, while 100% of the LSILs expressed the 2 cyclins. On the other hand, 100% of the samples NSIL with LR-HPV presented an episomal pattern. Of the specimens of NSIL with HR-HPV, 56.6% exhibited an episomal pattern, 23.3% integrated and 20%, mixed. Among the LSILs, 90% were mixed and 10% integrated. Conclusions: The cyclins A and E are present in the LSILs that occur predominantly in mixed state in the presence of HR-HPV.
  5,994 619 2
Conventional Pap smear and liquid based cytology for cervical cancer screening - a comparative study
RK Sherwani, T Khan, K Akhtar, A Zeba, FA Siddiqui, K Rahman, N Afsan
October-December 2007, 24(4):167-172
DOI:10.4103/0970-9371.41888  
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.
  5,796 805 3
Value of ultrasonography-guided fine needle aspiration cytology in the investigative sequence of hepatic lesions with an emphasis on hepatocellular carcinoma
CM Mallikarjuna Swamy, CA Arathi, CR Kodandaswamy
October-December 2011, 28(4):178-184
DOI:10.4103/0970-9371.86344  PMID:22090691
Background: The evaluation and management of various hepatic lesions is a common clinical problem and their appropriate clinical management depends on accurate diagnoses. Aims: To study the cytomorphological features of distinctive non-neoplastic and neoplastic lesions of the liver and to evaluate the sensitivity, specificity and diagnostic accuracy of ultrasonography (USG)-guided fine needle aspiration cytology (FNAC) in the diagnosis of liver diseases. Materials and Methods: Seventy - two patients with evidence of liver diseases underwent USG-guided, percutaneous FNAC. Cytomorphological diagnoses were correlated with clinical, biochemical and radiological findings, histopathological diagnoses and follow-up information. Results: The age of the patients ranged from eight months to 90 years with 48 males (66.67%) and 24 females (33.33%). Of the 72 cases, the cytological diagnosis was rendered in 71 patients and smears were inadequate for interpretation in one case. Neoplastic lesions (68.06%) were more common than non-neoplastic lesions (30.56%). The majority of the neoplastic lesions were hepatocellular carcinomas (36.12%) followed by metastatic adenocarcinomas (19.45%). Among non-neoplastic lesions, cirrhosis was the commonest lesion (8.34%). The overall diagnostic accuracy of FNAC was 97.82% with a sensitivity and specificity of 96.87 and 100% respectively. Conclusion: USG-guided FNAC of the liver is a safe, simple, cost-effective and accurate method for cytological diagnosis of hepatic diffuse, focal/nodular and cystic lesions with good sensitivity and specificity.
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