This study was undertaken to analyze the fine needle aspiration (FNA) cytologic, functional and immunologic features in Hashimoto's thyroiditis (HT) with special reference to ethnicity in Malaysian patients. 88 cases of HT retrieved from the archives of the cytology laboratory were reviewed. Ethnic, clinical, cytologic, biochemical, and immunologic features were correlated. HT was more common in Indian patients (57%). 33% of HT cases presented with nodular thyroid enlargement (47.5% were Chinese). 57.5% were euthyroid and 35% hypothyroid. Thyroglobulin antibody (TG Ab) and thyroid peroxidase antibody (TPO Ab) (tested in 29/88 cases) were elevated in 83% and 93% cases respectively. Review of cytologic smears showed Hurthle cells in 56% cases, high lymphoid to epithelial ratio in 38%, lymphoid follicles in 67%, follicular cell infiltration by lymphoid cells in 69% and lymphohistiocytic clusters in 40%. Giant cells and/or granulomas were present in 45% and plasma cells and/or immunoblasts in 40% of cases. 17% showed neutrophils and/or eosinophils infiltrating follicular epithelial cells. Follow up FNA of eight cases showed appearance of a diagnostic cytologic pattern in all and changes in clinical presentation in four. Hashimoto's thyroiditis was more common among Indian women with nodular presentation seen more often in Chinese. Hurthle cell change, lymphoid follicles and follicular cell infiltration by lymphoid cells, considered histologic hallmarks of HT, were seen less frequently. 17% cases showed infiltration of follicular cells by neutrophils and eosinophils, a hitherto undescribed feature in HT. Follow up cytology was helpful in monitoring progression of disease and arriving at a definitive diagnosis.

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Fine needle aspiration cytology (FNAC) is a valuable diagnostic tool and is replacing biopsy for the diagnosis of periarticular nodules. We present a case of fifty year old male with multiple soft tissue nodules in feet without any clinical and radiological features of arthritis. Fine needle aspiration revealed negatively birefringent needle shaped crystals consistent with monosodium urate crystals in amorphous granular debris. Diagnosis of gouty tophi was given. On follow up serum uric acid levels were found to be high and a diagnosis of gout was established. FNAC is a valuable diagnostic tool for the diagnosis of periarticular nodules and pathologists should be aware of cytological features of gouty tophi, particularly in cases of unusual presentation.

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Differentiation of hepatocellular carcinoma (HCC) from metastatic carcinoma in liver may be difficult on fine needle aspiration cytology (FNAC), when both appear as moderate to poorly differentiated tumours. The present study was done to assess clinical, serological, biochemical, radiological and detailed cytomorphological features to distinguish HCC from metastatic carcinoma in FNAC of the liver masses. The individual cytomorphological features which helped in differentiating HCC from metastatic carcinoma were: hepatocytic appearance of cells (92%), trabecular pattern (92%), naked nuclei (76%), intranuclear inclusions (52%) and bile (40%). The most common clinical presentation in HCC cases was pain abdomen (40%). Positivity for HBsAg was found in 7 (33.3%) cases while anti HCV antibody was detected in 4 (19%) cases. The level of serum alpha fetoprotein (AFP) was elevated in 88.9% cases, but 40% cases showed mild elevation of AFP level. 17/25 cases of HCC had solitary space occupying lesion (SOL) and 8 cases had multiple SOLs. The present study reveals that most useful cytomorphological features in the distinction of HCC from metastatic carcinoma include trabecular pattern, hepatocytic cells, bile pigment, intranuclear inclusions and atypical stripped nuclei in HCC. Viral markers and alpha-fetoprotein estimation can supplement the results.

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A case of thyroid swelling occurring in a 30 years old male, diagnosed as primary hydatid cyst of thyroid gland by fine needle aspiration cytology (FNAC) is being reported for its extreme rarity. The FNAC diagnosis of hydatid cyst of thyroid gland was made with certainty by the presence of fragments of hyaline laminated cell wall membrane, scolices, hooklets and few brood capsules in a background of cellular debris in the smears. The possibility of hydatid cyst should be kept in mind during the FNAC of a cystic lesion, even in an unusual location for it. Preoperative FNAC diagnosis of hydatid cyst will be helpful to take appropriate anti-anaphylactic measures and necessary care to avoid the spread of protoscolices during surgical extirpation of the cyst

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A 42 year old male from Kinnaur district of Himachal Pradesh presented with a subcutaneous nodule in the submandibular region. It was 2x3 cm in size, firm, mobile and non-tender. Lymphadenitis and sialadenitis were kept as differential diagnosis. Fine-needle aspiration revealed Leishman Donovan (L-D) bodies along with non-caseating epithelioid cell granulomas. We are presenting this report for its rarity.

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Primary thyroid lymphomas (PTL) are extremely uncommon neoplasms accounting for 5% of all thyroid malignancies. There are very few small series and occasional case reports of fine needle aspiration cytology (FNAC) of PTL in literature. We present an interesting and rare case of PTL diagnosed on FNAC. FNAC is an important tool in the diagnosis of thyroid lymphoma.

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A ten year retrospective study of 34 cases of Wilms' tumour in children is presented with 24 cases (70.5%) in the age group 0-5 years and a mean age of 4 years. A male: female ratio of 4.7:1 was seen. All the children presented with lump in abdomen, constitutional symptoms in addition were observed in 6 cases. Bilateral tumour was seen in 2 (5.8%) cases. A histocytomorphological correlation with regards to the differential diagnosis of small round cell tumours of childhood in abdominal cavity is discussed. The differential diagnosis of Wilms' tumour includes malignant round cell tumours such as neuroblastoma, non-Hodgkins lymphoma, rhabdomyosarcoma and other pediatric renal tumours such as mesoblastic nephroma, cystic nephroma, rhabdoid tumour and clear cell sarcoma. In cases with high clinical suspicion of Wilms' tumour, where preoperative chemotherapy and radiotherapy are indicated, fine needle aspiration cytology (FNAC) can act as a reliable diagnostic tool to complement the clinical diagnosis.

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Adenoid cystic carcinoma is a malignant neoplasm most commonly originating in salivary glands of head and neck region. Its occurrence elsewhere is rare and extension to thyroid even rarer. We report a 27 year old male who was diagnosed to have features of adenoid cystic carcinoma in fine needle aspirate of the thyroid swelling and subsequently confirmed by histopathology. Extensive search failed to reveal a primary. Awareness of cytology of adenoid cystic carcinoma and unusual presentation can help in making a diagnosis on cytology.

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Mammary Paget's disease is an uncommon intraepithelial adenocarcinoma which may or may not be associated with underlying carcinoma. Traditionally Paget's disease was diagnosed on excision biopsy. But now primary clinical impression along with scrape smear cytology is useful in the diagnosis. Scrape smear cytology where touching the microscopic slide to the weeping lesion or scraping the scaly lesion gently with slide is easy, quick, cost effective and non invasive. Here, we present a case of Paget's disease of nipple with underlying breast carcinoma diagnosed on scrape smear examination and fine needle aspiration cytology of underlying mass. Subsequent histopathological examination confirmed the diagnosis. Early diagnosis of the condition is helpful in planning therapy.

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Infection is the most common cause of mortality and morbidity within the first year of transplantation. Renal allograft recipients are susceptible to various opportunistic infections because of prolonged immunosuppression. The study was carried out to evaluate the role of cytology for rapid diagnosis of infections in transplant patients. Fine needle aspiration cytology (FNAC) of superficial lesions, guided aspirations from deep seated lesions, bronchoalveolar lavage, endoscopic brushings and urine cytology was the material studied. 292 renal transplants were done during a period of nine years. 46 cases of infections were diagnosed, comprising of bacterial (26), viral (2), fungal (13) and mixed bacterial and fungal (5). Cytological examination offers a rapid and specific diagnosis of infections in these immunocompromised patients. The incidence, severity of infection and mortality in post transplant patients will decrease with early diagnosis and high index of clinical suspicion.

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