Journal of Cytology
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   2008| January-March  | Volume 25 | Issue 1  
    Online since May 3, 2008

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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
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.
  19 16,022 1,485
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
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.
  10 8,371 807
Role of AgNORs in thyroid lesions on fine needle aspiration cytology smears
Sarita Asotra, Jaishree Sharma
January-March 2008, 25(1):18-22
Background: Fine needle aspiration has an important role in diagnosis of thyroid neoplasm. However, it is difficult to differentiate between follicular adenoma and follicular carcinoma by cytology alone. Recently, silver staining has been performed for nucleolar organizer regions (AgNORs) to differentiate various tumors. Aims: The present study was undertaken to see if the AgNOR technique could distinguish between benign and malignant lesions, particularly, follicular neoplasm. Materials and Methods: One hundred forty cases of thyroid lesions were examined, which included colloid goiter (n = 36), multinodular goiter (n = 38), subacute thyroiditis (n = 6), Hashimoto's thyroiditis (n = 17), lymphocytic thyroiditis (n = 3), follicular neoplasm (n = 18), Hurthle cell neoplasm (n = 3), papillary carcinoma (n = 16), and medullary carcinoma (n = 3). Diagnosis was confirmed by histopathology in 80 cases. The usual one-step silver colloidal reaction was performed at room temperature for 35 minutes and intranuclear dots of silver deposits were counted in 100 cells. Results: AgNOR counts of benign and malignant lesions were compared and were found to be statistically significant (P < 0.001). The mean AgNOR counts were higher in neoplastic lesions. Conclusions: AgNOR counting in fine needle aspiration smears is a simple, sensitive, and cost-effective method for differentiating benign from malignant thyroid follicular neoplasms.
  6 5,506 428
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
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.
  3 14,271 748
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
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.
  1 32,256 568
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
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.
  1 9,984 312
Fine needle aspiration cytology of Kikuchi's lymphadenitis
Gurdeep Singh, Venkateswaran K Iyer
January-March 2008, 25(1):36-37
  1 3,902 276
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
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.
  1 10,826 771
Metastatic gastric adenocarcinoma to the cerebrospinal fluid: A report of three cases
Sumedha A Kotwal, Sonali Bisht, Ramesh Dawar
January-March 2008, 25(1):25-27
Neoplastic meningitis is seen in five to ten percent of patients with solid tumors and is characterized by multifocal neurological signs and symptoms. The diagnosis is established by imaging, cerebrospinal fluid (CSF) cytology, and radioisotope CSF flow studies. Gastric adenocarcinoma is a rare cause of neoplastic meningitis. We review here CSF cytology results from our Oncology center obtained over two years and report three cases of gastric adenocarcinoma with cytologically positive CSF.
  - 6,264 256
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
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.
  - 8,738 282
Advent of liquid based preparations in India
Varsha Manucha
January-March 2008, 25(1):37-38
  - 3,140 347
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