Journal of Cytology
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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 38 | Issue 2
Page Nos. 57-111

Online since Saturday, May 15, 2021

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REVIEW ARTICLE  

Automated immunostaining platform in cytology p. 57
Shelly Sharma, Pranab Dey
DOI:10.4103/JOC.JOC_145_20  
Background: In the modern era, immunocytochemistry (ICC) is an essential part of investigations. There is now an increasing workload of ICC in laboratories. Automated immunostaining platform may help the laboratories to deal with such a rising burden of ICC. Summary: In this brief review article, we have described the various aspects of automated ICC, particularly the benefits, limitations, types of the system, working manner, and comparison of different commercially available systems.
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ORIGINAL ARTICLES Top

Is diagnosis of low-grade urothelial carcinoma possible in urine cytology? p. 64
Saloni Bansal, Saleem Pathuthara, Santhosh Joseph, Swati Dighe, Santosh Menon, Sangeeta B Desai
DOI:10.4103/JOC.JOC_193_18  
Background: Urine cytology is a useful modality, primarily for the diagnosis and follow-up surveillance of high-grade urothelial carcinoma (HGUC). Its utility in diagnosing low-grade urothelial carcinoma (LGUC) remains controversial because of low reported sensitivity compared to cystoscopy. Aim: To study the cytomorphology of LGUC in voided urine samples and analyze its utility in diagnosis. Materials and Methods: This is a retrospective study of one year, including 48 voided urine samples in cases which were confirmed as LGUC on subsequent histology. Urine cytology smears of these cases, originally stained with Papanicolaou stain were reviewed, critically analyzed and the specific cytomorphologic and cystoscopic findings were documented. Results: On review 18 samples were re-categorized as LGUC which included 10 samples initially diagnosed as Negative for HGUC, 2 as Atypical Urothelial Cells – Not Otherwise Specified (AUC-NOS) and 6 as Suspicious for Carcinoma. In addition, another 3 samples with initial diagnosis of LGUC remained as LGUC on review. Thus, a total of 21 LGUC samples were identified after the review. 26 (54%) samples with a diagnosis of negative for HGUC remained negative even after review, as the tumor cells were not identified either due to sampling error or unrecognizable morphology. One (2%) samples of AUC-NOS remained the same on review due to very scant atypical cells. In 21 LGUC samples, cytology showed a dual population of benign differentiated urothelial cells and small urothelial cells with subtle nuclear atypia such as irregular and thickened nuclear membrane with increased nuclear cytoplasmic ratio. In 12 false negative LGUC samples, the diagnostic cells were camouflaged by their subtle nuclear atypia coupled with an overwhelming background of differentiated benign urothelial cells as both appeared almost similar in morphology. Papillary fragments were identified only in 2 samples. Conclusions: Diagnosis of LGUC on cytology is challenging and depends on the presence of diagnostic cells, pick up of diagnostic cells on screening and accurate interpretation. Special attention to papillary fragments and aforementioned nuclear atypia should be paid as tumor cells may resemble normal urothelial cells and can be easily missed.
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Effectuation of international academy of cytology yokahama reporting system of breast cytology to assess malignancy risk and accuracy p. 69
Vaddatti Tejeswini, B Chaitra, IV Renuka, Kasula Laxmi, Potti Ramya, K K S Sowjanya
DOI:10.4103/JOC.JOC_20_20  
Introduction: Recently the International Academy of Cytology (IAC) proposed a new Yokahama reporting system for breast fine-needle aspiration cytology (2019) in order to standardize reporting pattern and to link cytology reporting to management algorithms. Aims and Objectives: To categorize the samples according to the newly proposed IAC Yokahama reporting system of breast cytology and to assess diagnostic accuracy and corresponding risk of malignancy (ROM) for each category. Materials and Methods: This is a retrospective study of breast cytology cases done at Department of Pathology. The slides are retrieved from pathology archives and classified using a recently proposed IAC, Yokahama reporting system of breast cytology into five categories. The risk of malignancy, sensitivity, specificity, and diagnostic accuracy were estimated on the basis of the final histopathological diagnosis. Results: Of the 386 cases of breast FNAC, 226 (55.55%) had the corresponding histological diagnosis. The respective ROM for each category was 22.22% for category 1 (insufficient material), 5.32% for category 2 (benign), 26.31% for category 3 (atypical), 100% for category 4 (suspicious for malignancy), and 100 % category 5 (malignant). Malignant cases were considered only when positive tests, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 89.66%, 100%, 100%, 90.2%, and 94.69%, respectively. Conclusions: The present study showed statistically significant sensitivity, specificity, and diagnostic accuracy, especially with malignant cases. Hence, using the IAC Yokahama reporting system of breast cytology is effective to standardize the reporting in various institutes and provide clear guidelines to clinician for further management.
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The utility of ancillary techniques in the cyto-diagnosis of malignant scalp lesions p. 74
Saumya Shukla, Anurag Gupta, Namrata P Awasthi, Subrat Chandra, Pradyumn Singh, Shilpa Kapoor
DOI:10.4103/JOC.JOC_22_19  
Background: Fine needle aspiration cytology (FNAC) is rapid, inexpensive, and easy technique to establish the diagnosis of scalp lesions. The use of ancillary techniques such as immunocytochemistry (ICC), immunohistochemistry (IHC), and flow cytometry on aspiration material aids in accurate diagnosis which is additionally beneficial for management and prognosis. Aims: The objective of this prospective case series was to evaluate the utility of ancillary techniques in the accurate cyto-diagnosis of malignant scalp lesions. Materials and Methods: This study was a prospective case series that included 64 cases of scalp lesions in which FNAC had been performed for diagnosis. The lesions were categorized as Non-diagnostic/Inadequate, Inflammatory, Benign and Malignant. In all the cases that were categorized as malignant additional material was collected for ancillary testing that included ICC, cell block preparation followed by IHC and flow cytometry. Results: Non-diagnostic/inadequate aspirates were 17.19% (n = 11/64), 25% (n = 16/64) aspirates were inflammatory, 35.93% (n = 23/64) aspirates were benign and 21.87% (n = 14/64) aspirates were categorized as malignant. With the aid of ancillary techniques, 57.14% malignant scalp aspirates were accurately categorized as epithelial origin. Lesions of bone and soft tissue constituted 28.57% (n = 4/14) of cases and lesions of hematolymphoid origin constituted 14.29% (n = 2/14) of all cases. Conclusion: This is a novel study where accurate categorization of malignant scalp tumors has been done with the use of ancillary techniques. This is useful as it may help in defining the tumor type, may aid in patient management. The material obtained can also be triaged for molecular testing.
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Prognostic Role of Intragastric Cytopathology and Microbiota in Surgical Patients with Stomach Cancer p. 82
Edoardo Virgilio, Enrico Giarnieri, Elisabetta Carico, Monica Montagnini, Sandra Villani, Michele Fiorenti, Marco Cavallini, Filippo Montali, Renato Costi
DOI:10.4103/JOC.JOC_238_20  
Background: In the last decade, analysis of malignant cells and flora in gastric lavage (GL) has provided interesting data on pathogenesis of gastric cancer (GC). For this study, combining such two aspects into one cyto-microbiologic category, we tested the prognostic role of the presence/absence of cancer cells (GL1/GL0) and bacterial microbiota (MB1/MB0) in our GC population. Material and Methods: Between April 2012 and August 2019, 79 surgical patients with GC were prospectively investigated with the determination of GL MB. Results: Compared with GL1 MB0, GL1 MB1 strongly correlated with advanced GC, portended poorer overall survival (OS) (45.8 months vs 20.5 months, P = 0.049), and resulted a significant (P = 0.008) and an independent (P = 0.013) prognostic factor unfavorable for OS. Conclusion: In the light of our results, the cyto-microbiologic parameter of GL MB should be used to gain a better prognosis of GC patients. Administration of antimicrobial treatment for MB1 subjects should be entertained because it could reduce the risk of oncogenesis.
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A clinicopathological diagnostic and therapeutic approach to cytolytic vaginosis: An extremely rare entity that may mimic vulvovaginal candidiasis p. 88
Uguray P Hacisalihoglu, Ferruh Acet
DOI:10.4103/JOC.JOC_169_20  
Objectives: Cytolytic vaginosis is a very rare entity that may be clinically misdiagnosed as vulvovaginal candidiasis. The aim of this study was to determine the incidence of cytolytic vaginosis in patients displaying symptoms similar to vulvovaginal candidiasis and to develop a clinicopathological diagnostic and therapeutic approach. Materials and Methods: In total, 3000 cervical smear samples were evaluated at our center between 2015 and 2018. Patients whose PAP smears demonstrated significant epithelial cytolysis, naked nuclei, excessive increase in lactobacilli population, absent or minimal neutrophils and no microorganisms were subjected to a symptom assessment questionnaire and had their vaginal pHs measured. They were classified into two groups according to their complaints, symptoms and vaginal pHs: Cytolytic vaginosis and Asymptomatic intravaginal lactobacillus overgrowth. A standardized NaHCO3 Sitz bath therapy was applied to the cytolytic vaginosis group. Results: Fifty-three of the patients (1.7%) were diagnosed as cytolytic vaginosis. After Sitz bath therapy, there was a statistically significant decrease in the cytolysis and lactobacillus scores of the patients. Vaginal discharge of 43 (81%) patients ceased completely while that of the remaining 10 (19%) patients decreased after the therapy. The improvement was statistically significant (P < 0.001). There was a complete resolution in 28 (96%) patients with severe; and in 21 (94%) patients with intermediate vaginal discomfort, after the therapy. Dyspareunia was resolved in 35 (97%) patients (P < 0.001). Conclusion: Cytolytic vaginosis is a rare entity that can be diagnosed with the help of cytopathology and has a therapy based on the modulation microbiota by decreasing the vaginal pH.
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Validation of CINtec® PLUS cytology kit in the diagnosis of persistent HPV infections - Cohort study in the Portuguese population p. 94
Ângela L Abreu, Regina A Silva, Sílvia Fernandes
DOI:10.4103/JOC.JOC_173_20  
Context: The use of the CINtec® PLUS Cytology Kit as a complementary method of diagnosis is intended to contribute to a risk assessment of CIN II+ cervical lesions development, thus avoiding unnecessary colposcopy in negative cases. This method has proved to be effective in the follow-up of cervical lesions, although there is need for consistency in the approach of equivocal or negative cytological results, with persistent positive High-Risk Human Papillomavirus (HR-HPV) test. Aims: The present study intends to retrospectively evaluate the capacity of the CINtec® to add information to the clinical practice within the screening and follow-up of cervical lesions. Additionally, this study intends to define criteria for CINtec® referral in order to maximize its utilization in the Portuguese context. Materials and Methods: For this purpose, 225 cases with CINtec® PLUS Cytology Kit and histology results were used, and data were analysed and compared according to the cytology and HR-HPV molecular test results. Results: The data of this study show that CINtec® PLUS Cytology Kit is a valid test for the diagnosis of persistent HPV lesions (p = 0.0005), with excellent sensitivity and reliable values of specificity. Relevant patient groups to apply the kit are in agreement with the manufacturer recommendations: women with ASC-US/LSIL result and NILM cytology with HPV-positive test, essentially over 30 years old. Conclusions: Although clinical data and previous cytological information must help guiding, authors considered that CINtec® is a really valid test for the prognosis of persistent HPV infections in the female population.
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IMAGES IN CYTOPATHOLOGY Top

Primary diagnosis of epithelioid hemangioendothelioma in pleural effusion based on cytologic features and vascular marker immunocytochemical staining p. 101
Amal Abd El hafez
DOI:10.4103/JOC.JOC_18_21  
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Not all lymphadenopathy and dyspnea in retropositive represent tuberculosis p. 104
Bidish K Patel, Ashish R Singh, Neelaiah Siddaraju
DOI:10.4103/JOC.JOC_17_21  
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Disseminated infection of Nocardia farcinica in an immunocompetent adult: Mistaken for tuberculosis bacilli in acid-fast staining of bronchoalveolar lavage fluid p. 106
Yahong Bai, Keyu Liu, Yanqiang Chen, Hebao Zhao, Yuqing Wang, Xiaojin Liu, Liheng Zheng
DOI:10.4103/JOC.JOC_208_20  
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LETTERS TO EDITOR Top

Extramedullary hematopoiesis in lymphangioma - A cytological study p. 109
Pritika Kushwaha, Meeta Singh, Shyama Jain, Sujoy Neogi
DOI:10.4103/JOC.JOC_206_20  
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Inguinal lymph node metastasis in a case of recurrent biphasic synovial sarcoma-A cytologic diagnosis p. 110
Arshiya Bose, Prita Pradhan, Kanakalata Dash, Urmila Senapati, Saroj Ranjan Sahoo, Sabyasachi Parida
DOI:10.4103/JOC.JOC_51_20  
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