Journal of Cytology
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   2014| July-September  | Volume 31 | Issue 3  
    Online since November 29, 2014

 
 
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ORIGINAL ARTICLES
Diagnostic utility of bronchoalveolar lavage
Sistla Radha, Tameem Afroz, Sudheer Prasad, Nallagonda Ravindra
July-September 2014, 31(3):136-138
DOI:10.4103/0970-9371.145636  PMID:25538381
Introduction: Bronchoalveolar lavage (BAL) is a diagnostic procedure by which cells and other components from bronchial and alveolar spaces are obtained for various studies. One of the main advantages of BAL is that it can be done as a day care procedure. Material obtained by BAL can give a definite diagnosis in conditions such as infections and malignancies. Aims: The aims and objective of this study were to assess the utility of BAL as a diagnostic tool to determine the diagnostic accuracy of the material obtained from BAL in various infections and neoplastic lesions to study the limitations of BAL in certain lung disorders. Materials and Methods: This study was done in a tertiary care center in Hyderabad. Bronchoscopy was done as an outpatient procedure and lavage fluid obtained analyzed. This is a prospective study done from January 2012 to Jun 2013. Ninety-one BALs were analyzed for total and differential count, microbiological examination and cytological evaluation. Cases selected included nonresolving pneumonias, diffuse lung infiltrates, infiltrates in immunosuppressed hosts and ventilator-associated pneumonias. Results: Bronchoalveolar lavage was done in 91 cases over a period of 1½ years. Definite diagnosis was not given in 7 cases. Four cases were inadequate. Tuberculosis was diagnosed in 22 cases, fungal infections in 7 cases. Thirty-eight cases of bacterial pneumonias were diagnosed, Klebsiella was the most common organism. Malignancy was diagnosed in 13 cases. Conclusion: Definite diagnosis can be made in tuberculosis, fungal infections, bacterial pneumonias and in malignancies.
  2,493 316 5
Flow cytometric immunophenotyping and cell block immunocytochemistry in the diagnosis of primary Non-Hodgkin's Lymphoma by fine-needle aspiration: Experience from a tertiary care center
Tuhin Paul, Upasana Gautam, Arvind Rajwanshi, Ashim Das, Amita Trehan, Pankaj Malhotra, Radhika Srinivasan
July-September 2014, 31(3):123-130
DOI:10.4103/0970-9371.145577  PMID:25538379
Background: Accurate diagnosis of Non-Hodgkin's Lymphoma (NHL) on fine-needle aspiration (FNA) specimen is challenging and requires ancillary testing. Aim: The feasibility of flow cytometric immunophenotyping (FCI) along with cell block immunocytochemistry (CB-ICC) as adjunct techniques in the diagnosis of NHL as per the current World Health Organization (WHO) classification was evaluated. Materials and Methods: All cases of suspected lymphoma underwent FNA, and the sample was triaged for light microscopic evaluation, FCI, and CB-ICC, and each case was classified as per the current WHO classification. Results: A total of 65 cases was analyzed which included 40 B-cell, 21 T-cell, and 4 unclassifiable lymphomas. Of 61 cases, FCI alone was contributory in 74% (45/61) cases whereas CB-ICC alone was contributory in 65.5% (40/61) cases in typing the lymphoma. In 11.4% (7/61) cases, the lymphoma could not be classified by either technique. Thus, in a total of 88.5% (54/61) cases a combination of FCI and CB-ICC from FNA enabled a diagnosis of lymphoma with its subtyping. Conclusion: Flow cytometric immunophenotyping and ICC on CBs are feasible on FNA material and are very useful in a suspected case of NHL especially when a biopsy may not be possible or feasible.
  2,448 237 8
Correlation between cytological and histopathological examination of the endometrium in abnormal uterine bleeding
Navjot Kaur, Jagjit S Chahal, Usha Bandlish, Rashmi Kaul, Kavita Mardi, Harjit Kaur
July-September 2014, 31(3):144-148
DOI:10.4103/0970-9371.145645  PMID:25538383
Background: Abnormal uterine bleeding (AUB) is a common problem for which women seek gynecological consultation. Endometrial aspiration cytology (EAC) is an acceptable and valuable diagnostic procedure for screening the endometrial status. Aims: The purpose of our study was to describe the spectrum of endometrial lesions along with their cytomorphological features as well as to compare the results of EAC with histopathology of the endometrial curettings obtained as a result of dilatation and curettage (D and C), in order to assess the value of the former and its shortcomings. Materials and Methods: Endometrial aspiration using a menstrual regulation (MR) syringe and a 4 mm Karman's cannula was performed just prior to D and C in 100 women presenting with AUB. Smears were reviewed for cytomorphological findings and were correlated with the histopathological findings. These findings were categorized as benign endometrium, endometrial hyperplasia, malignancy and inadequate smears. Results: Age of the patients ranged from 19 to 70 years. In our study, the accuracy in diagnosing benign conditions of endometrium, hyperplasia, and malignancy on aspiration cytology were 93.88%, 96.94% and 96.84%, respectively. Conclusions: Endometrial aspiration is an effective, useful and a minimally invasive procedure. With an experienced cytologist, it can be used routinely for the primary investigation of women with AUB, provided all the points of discrepancies are taken care of.
  2,244 313 3
Evaluation of ploidy status using DNA-image cytometry of exfoliated mucosal cells in oral lichen planus
Ravi Teja Chitturi, R Madhavan Nirmal, Paramel Mohan Sunil, A Santha Devy, B Venkat Ramana Reddy
July-September 2014, 31(3):131-135
DOI:10.4103/0970-9371.145629  PMID:25538380
Background: Oral lichen planus (OLP) is one of the potentially malignant disorders (PMDs) with a malignancy rate of 0.2-2%. Aneuploidy is considered to be one of the important markers for malignant transformation and DNA-image cytometry (DIC) has been successfully employed in oral mucosal PMDs and also in tumors of the cervix, lung and biliary tract. Aims: In this study, we intend to assess the ploidy status of exfoliated cells in OLP using DIC. Materials and Methods: Exfoliated cells from 48 patients with different subtypes of OLP (reticular, plaque type, erosive and atrophic) and 10 controls were stained using Feulgen reaction and assessed for integrated optical density using image analysis software and the ploidy status was assessed. Results: All the patients in the control group and most of the patients (93.5%) who had reticular or plaque type of OLP (29 out of 31) exhibited diploid nuclei in the smears, whereas 11 patients who had erosive or atrophic types of OLP showed aneuploid nuclei. Conclusions: The patients with erosive or atrophic types of OLP are at more risk and assessment of ploidy status by exfoliative cytology can be used as an adjuvant for diagnosis.
  2,123 142 5
Nuclear morphometric and morphological analysis of exfoliated buccal and tongue dorsum cells in type-1 diabetic patients
Zehra Safi Oz, Sibel Bektas, Fatih Battal, Hulusi Atmaca, Bahri Ermis
July-September 2014, 31(3):139-143
DOI:10.4103/0970-9371.145642  PMID:25538382
Background: Diabetes mellitus type 1 that results from immunologically mediated damage to the β-cells in the pancreas. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia. Hyperglycemia can be associated with salivary gland dysfunction and alterations in the oral epithelial cells. Aim: The aim of this study was to evaluate the qualitative and quantitative changes in buccal and tongue dorsum epithelial cells using an exfoliative cytology method in type 1 diabetic patients. Materials and Methods: We performed light microscopic analysis of the buccal and tongue dorsum smears in thirty type 1 diabetic patients and thirty healthy individuals. The oral smears were stained using Papanicolaou method for cytological examination and nuclear morphometric analysis. In each case, the mean nuclear area, perimeter, length, breadth, and roundness factor were evaluated in each smear using the image analysis software (Q Win, Leica TM ). Results: The nuclear area, length, breadth, and perimeters were significantly higher in the diabetic group from tongue dorsum smear than that of the control group (P < 0.05). In the cytological examination, karyorrhexis-karyolysis-karyopyknosis, binucleation, nuclear membrane irregularity, cytoplasmic polymorphism, perinuclear halo were observed in oral smears with type 1 diabetic patients. Binucleation (P = 0.002) and nuclear membrane irregularity (P = 0.024) were significantly more common in buccal smears of diabetic group. Furthermore, the sensitivity of buccal mucosa was significantly higher in the diabetic group (P = 0.006). Conclusion: The light microscopic and nuclear morphometric study indicates that type 1 diabetes can produce morphological and nuclear morphometric changes in the oral mucosa that are noticeable with exfoliative cytology.
  2,054 167 3
Efficacy of rapid, economical, acetic acid, Papanicolaou stain in cervical smears as an alternative to conventional Papanicolaou stain
Shabnam Izhar, Rupinder Kaur, Kanwal Masih
July-September 2014, 31(3):154-157
DOI:10.4103/0970-9371.145648  PMID:25538385
Background: Papanicolaou (Pap) stain has been used over the years for cervical cytology screening. However; it utilizes a considerable amount of alcohol which is expensive and difficult to procure. In one of the modifications, ethyl alcohol is replaced by 1% acetic acid and is termed as rapid, economical, acetic acid Papanicolaou (REAP) stain. It is cost effective, easily available and provides a suitable and rapid staining alternative. Aim: This study was undertaken to assess the efficacy of REAP stain as an alternative method to conventional Pap stain. Materials and Methods: This study was done over a period of 18 months in a tertiary care hospital. Two sets of cervical smears were prepared of which one was stained with conventional Pap stain, and other was stained with REAP stain. The smears were examined for cytomorphological parameters and were evaluated using a modification of parameters given by Ng et al. Results: A total of 737 smears were examined in duplicate. Most of the conventional Pap smears showed excellent preservation (91.6%) with very few showing optimal (7.6%) and sub-optimal staining (0.8%). In contrast to this excellent preservation was seen in just 33.6% of the REAP stained smears with majority showing optimal and sub-optimal preservation (46.5% and 20% respectively). The P value was statistically significant (<0.0001) depicting inferior staining quality of REAP stain. Conclusion: Rapid, economical, acetic acid Papanicolaou stain undoubtly is a simple, fast and cost effective stain which can be adopted mainly in resource limited settings, but cannot be utilized for research purpose in a tertiary care setup due to poor preservation of the staining quality.
  1,760 237 3
CASE REPORTS
Ameloblastoma: Cytopathologic profile of 12 cases and literature review
Vidyadevi Chandavarkar, K Uma, Mithilesh Mishra, R Sangeetha, Radhika Gupta, Ritika Sharma
July-September 2014, 31(3):161-164
DOI:10.4103/0970-9371.145652  PMID:25538387
Background: Fine-needle aspiration cytology (FNAC) has been used as a diagnostic tool in evaluating suspected lesions. It shows a high diagnostic accuracy for diagnosing salivary gland lesions. Aim: The aim of this study was to highlight FNAC as an effective diagnostic tool in the presumptive diagnosis of ameloblastoma. Materials and Methods: A total of 12 cases of ameloblastoma sampled by FNAC retrieved from the archives of the Oral Pathology Department were retrospectively studied. The smears were alcohol-fixed and stained with hematoxylin and eosin. All the 12 cases of FNAC had subsequent corresponding surgical incisional biopsy or excision specimens. Results: Cytologically, seven cases were diagnosed as benign odontogenic tumor more in favor of ameloblastoma. All the 12 fine-needle aspiration cases were given a histopathologic work-up and diagnosed as ameloblastomas. Of these, the seven cytologically diagnosed benign odontogenic lesions were also confirmed to be ameloblastoma by both incisional biopsy as well as surgical excision. Conclusion: It was deduced from the above results that FNAC helps potentially in diagnosing ameloblastoma.
  1,441 156 1
Solitary bone plasmacytoma: An interesting case report with unusual clinico-cytological features
Annapurna Saksena, Nidhi Mahajan, Shipra Agarwal, Shyama Jain
July-September 2014, 31(3):158-160
DOI:10.4103/0970-9371.145650  PMID:25538386
Solitary bone plasmacytoma (SBP) is a rare entity characterized by localized proliferation of monoclonal plasma cells primarily occurring in the axial skeleton without systemic involvement. Involvement of the distal extremity is unusual. In the absence of typical clinical presentation, diagnosis may not be suspected clinico-radiologically; hence, fine-needle aspiration cytology may help in early and definitive diagnosis, hastening meticulous diagnostic workup and appropriate management of these patients. Intracytoplasmic crystalline inclusions (CI) have been reported in multiple myeloma and lymphoproliferative disorders. The present case highlights unusual clinico-cytological features of SBP with primary involvement of humerus, progression to tibia, and presence of extracellular and intracytoplasmic CI in plasma cells, a morphologic finding not reported in SBP earlier.
  1,484 100 -
ORIGINAL ARTICLES
Correlation of eosinophilic structures with detection of acid-fast bacilli in fine needle aspiration smears from tuberculous lymph nodes: Is eosinophilic structure the missing link in spectrum of tuberculous lesion?
Dev Prasoon, Parimal Agrawal
July-September 2014, 31(3):149-153
DOI:10.4103/0970-9371.145647  PMID:25538384
Background: Acid-fast bacilli (AFB) is not seen in all necrotic tuberculous lesions. If the subset of tuberculous lesions which yield positive result for AFB can be identified, it would save on time and manpower besides optimizing use of resources. A prospective study was undertaken to assess if presence of eosinophilic structures (ESs) in necrotic tuberculous lesions correlated with the presence of AFB. Materials and Methods: Patients referred for fine needle aspiration cytology for evaluation of lymphadenopathy between July 2012 and June 2013 were analyzed. The hematoxylin and eosin and May-Grünwald-Giemsa stained slides were screened for epithelioid cell granuloma, ES and necrosis and Ziehl Neelsen stained smears for AFB. Result: One hundred and eight tuberculous lymph nodes yielded necrotic material on aspiration. Four cytologic pictures were seen: (a) ES + AFB + in 58.33%, (b) ES + AFB in 20.37%, (c) ES AFB + in 9.26% (d) ES AFB in 12.04% cases. Overall AFB was found in 67.59% cases, out of which 58.33% correlated with the presence of ES while 9.26% were seen in smears without ES. Conclusion: Presence of ESs should be included in the morphological description of tuberculous lesions. In the absence of granulomas, they indicate tuberculous nature of the lesion. Presence of ES mandates a search for AFB as probability of finding AFB is high in such lesions. Significance of ES lies in their presence and not in their absence. Eosinophilic structures appear to be the missing link in the spectrum of tuberculous lesion.
  1,413 166 -
CASE REPORTS
Fine-needle aspiration cytology of chondroid syringoma of fore arm: Report of a rare case
Subrata Pal, Sanjay Sengupta, Sritanu Jana, Kingshuk Bose
July-September 2014, 31(3):171-173
DOI:10.4103/0970-9371.145659  PMID:25538390
Chondroid syringoma is a rare benign adnexal tumor of sweat glands with microscopic resemblance to the salivary gland pleomorphic adenoma. Cytology is rarely utilized for preoperative assessment of these slow-growing, small, nodular lesions. Definitive cytological diagnosis is also quite difficult, and majority of the aspirates are evaluated as benign adnexal tumors leading to mandatory histopathological examination for pinpoint diagnosis. Here, we report a case of chondroid syringoma of forearm, which was diagnosed by cytology and also confirmed after histopathological examination. Pinpoint cytological diagnosis can help early formulation of necessary management protocol.
  1,355 97 4
Incidental diagnosis of filariasis in association with carcinoma of gall bladder: Report of a case evidenced on ultrasound-guided fine-needle aspiration cytology with review of the literature
Rajani Sinha, Sanjay Sengupta, Subrata Pal, Anindya Adhikari
July-September 2014, 31(3):174-175
DOI:10.4103/0970-9371.145662  PMID:25538391
Lymphatic filariasis is endemic in India and South-East Asia. Detection of microfilaria is infrequently reported during cytological evaluation of various lesions or body cavity fluids. Microfilariae in cytological smears of few benign and malignant neoplasms have also been reported. Here we present a very rare case of presence of microfilariae in a smear from ultrasound guided fine-needle aspiration of gallbladder adenocarcinoma. The present patient is probably the second reported case in the literature harboring occult filariasis in association with gallbladder carcinoma. Though it is a chance finding, cytology can be an effective tool for detection of asymptomatic filariasis helping to pave the way of disease eradication.
  1,296 91 2
Penile neurilemmoma: Utility of fine-needle aspiration cytology in diagnosis of a rare entity
Kiran Preet Malhotra, Saumya Shukla, Anurag Gupta, Namrata Punit Awasthi, Nuzhat Husain, lshwar Ram Dhayal
July-September 2014, 31(3):176-178
DOI:10.4103/0970-9371.145663  PMID:25538392
Subcutaneous lesions in the penis are of rare occurrence and encompass benign as well as malignant tumors. These include lipomas, leiomyomas, neurilemmomas and their malignant counterparts. A surgical excision at this site carries the risk of postoperative penile curvature and erectile dysfunction. We report a rare case of penile neurilemmoma which presented as a subcutaneous nodule on the dorsal surface of the penis. A fine-needle aspiration was performed which aided in the preoperative diagnosis and guided the extent of excision. We report this case to highlight the importance of needle aspiration as a simple outdoor procedure for penile lesions which can aid surgical approach and postoperative outcome.
  1,313 60 1
Lymphadenopathic form of solid variant of alveolar rhabdomyosarcoma: A rare case report
Tanya Sharma, Ruchika Bhargava, Juhi Sharma, Surendra Pal Sharma
July-September 2014, 31(3):168-170
DOI:10.4103/0970-9371.145656  PMID:25538389
Lymph node enlargement due to metastatic rhabdomyosarcoma, without an obvious primary tumor, is rare. We report a fine-needle aspiration diagnosed and histopathologically confirmed case of solid variant of alveolar rhabdomyosarcoma in a 13-year-old female. She presented with right cervical lymphadenopathy, followed by a diffuse swelling in right forearm 2 months later.
  1,290 68 2
Direct sampling of metastatic ovarian carcinoma masquerading as endocervical adenocarcinoma in liquid-based cytology cervical sample
Nalini Gupta, Vikrant Bhar, Pranab Dey, Arvind Rajwanshi, Vanita Suri
July-September 2014, 31(3):165-167
DOI:10.4103/0970-9371.145654  PMID:25538388
Cervical sample is routinely taken to identify squamous dysplastic lesions of the cervix. Glandular lesions are far less commonly reported on cervical samples. The most common glandular lesion reported on cervical smear is endocervical adenocarcinoma, followed by endometrial adenocarcinoma. Direct sampling by Cervex brush is possible even in endometrial adenocarcinoma, if the tumor directly involves lower uterine segment/endocervical canal. Metastases to cervix are rare but have occasionally been reported in previous reports. We wish to highlight in this case, metastatic ovarian carcinoma directly sampled in cervical liquid-based cytology (LBC) sample, which mimicked cytomorphologically a well-differentiated endocervical adenocarcinoma. To the best of our knowledge, a similar case has not been previously published in SurePath LBC sample.
  1,268 72 -
LETTERS TO EDITOR
Scrape cytology in localized oral mucosal leishmaniasis
Anita Nangia, Shivali Sehgal, Ram Chander
July-September 2014, 31(3):180-181
DOI:10.4103/0970-9371.145668  PMID:25538394
  1,106 76 -
Fine-needle aspiration cytology of recurrent Merkel cell carcinoma of eye-brow
Anju Khairwa, Pranab Dey, Amanjit Bal
July-September 2014, 31(3):179-180
DOI:10.4103/0970-9371.145666  PMID:25538393
  1,001 57 3
Aspergillus involving submandibular salivary gland: An unusual presentation
Ruchita Tyagi, Pranab Dey
July-September 2014, 31(3):181-182
DOI:10.4103/0970-9371.145671  PMID:25538395
  867 63 -
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