Journal of Cytology
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Year : 2022  |  Volume : 39  |  Issue : 5  |  Page : 26-53
Abstracts: Poster Presentation

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Date of Web Publication28-Oct-2022

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. Abstracts: Poster Presentation. J Cytol 2022;39, Suppl S1:26-53

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. Abstracts: Poster Presentation. J Cytol [serial online] 2022 [cited 2023 Feb 5];39, Suppl S1:26-53. Available from:

 Pap smear More Details and Liquid Based Cervical Cytology in Terms of Diagnostic Accuracy">   PP-001: A Comparative Analysis of Conventional Pap Smear and Liquid Based Cervical Cytology in Terms of Diagnostic Accuracy Top

Shilpi Agarwal; Department of Pathology, Lady Hardinge Medical College, New Delhi, India

Introduction: The conventional pap test is considered an efficient and easy to apply methodology for cervical cancer screening. However, despite its well known methodology this test has high rates of false negatives. Liquid based cytology is the most accepted method, in which obscuring inflammatory cells, mucus & blood are removed. Aim: In present study, we compared the satisfactory and unsatisfactory rate of conventional smear (CS) and liquid based cytology smear (LBC). Methods: Study included 1200 patients between 2016 to 2018 with age group 20-70 years who presented with bleeding per vagina, post coital bleeding & irregular mensuration. CS and LBC sure path was prepared for each patient. Assessment was done using Bethesda System for reporting cervical cytology 2014. Results: The satisfactory rate of smears was higher in LBC – 94% (1129/1200) as compared to CS-83.8% (1005/1200) which was statically significant (p value <0.001). The unsatisfactory rate was higher in CS 16.2 % (105/1200) as compared to LBC – 5.8% (71/1200) which was statically significant (p <0.001). The main cause of unsatisfactory in CS was low squamous cellularity – 58.9% (115/125) followed by obscured by blood & inflammation– 32.9% (64/195). In case of LBC, the most common cause of unsatisfactory smears was due to low squamous cellularity-92.9% (66/71) and 4.3% (3/71) was due to obscured by blood and inflammation. Conclusion: Low squamous cellularity was may be due to splitting of sample for ancillary testing. Therefore, splitting of sample is not advised for liquid based cytology.

   PP-002: Atypical Glandular Lesions on Cervical Cytology Top

Aanchal, Poonam Abhay Elhence, Sudeep Khera, Deepak Vedant, Divya Aggarwal, T. Balamurugan, Pratibha Singh, Shashank Shekhar; All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Introduction: Diagnosis of atypical glandular cells on cervical cytology (AGCs) is challenging due to overlapping features of various neoplastic and nonneoplastic lesions. The incidence of squamous cell carcinoma of cervix has decreased with advent of Pap smear, whereas, incidence of glandular abnormalities, has increased with greater sensitivity. A high degree of suspicion, good clinical history and presence of diagnostic cytomorphological findings are essential for proper interpretation of glandular cell abnormalities. The aim of this study was to assess the utility of conventional Papanicolaou (Pap) smears and liquid based cytology (LBC) smears in detecting uterine glandular lesions. Materials and Methods: Smears for cervical cytology are collected using either Pap or LBC smear from patients in the age group of 20-75 years with complaints of abnormal bleeding. In AIIMS Jodhpur, from January 1, 2021 to July 31, 2022 a total of 46 patients had a diagnosis of AGC made by conventional cervical Pap or LBC smear interpretation. 37 (80.43%) patients had subsequent histological examination. Results: 29.7% (11/37) were associated with tissue- proven precancerous and/or cancerous lesions. 70% (26/37) of all AGC-patients were asymptomatic. Conclusion: As 29.7% of the patients in our series had significant cancerous and precancerous conditions found, patients with not qualified AGC-diagnosis require complete and careful evaluation and may need to be on follow-up.

   PP-003: Review of Visual Inspection of Cervix Using Acetic Acid (Via) Positive Cervical Biopsy in a Tertiary Care Center – Prospective Study Top

Khushboo Sinha, Sudha Iyengar, Rajesh Gaur; Gajraraja Medical College, Gwalior, Madhya Pradesh, India

Background: Cervix carcinoma is a major public health problem in developing country. Second most common carcinoma in female in India is cervical carcinoma and in our low resource settings screening of CIN and cervix carcinoma by VIA is more easily available and cheaper method. Aim: To document histopathological findings in cervical biopsies categorized as VIA positive which were received in Pathology department of Gajraraja medical college, Gwalior, Madhya Pradesh. Materials and Methods: Formalin fixed, paraffin embedded blocks of cervical biopsies were received from VIA positive areas. These were stained with H & E staining. Results were classified and analyzed on the basis of histopathological findings. Results: We had taken 103 cases out of which 40 cases (38.9%) were VIA positive and biopsy was taken form acetowhite area, 31 cases (77.5%) were reported as chronic cervicitis. There were 7 cases (17.5%) of cervical intraepithelial neoplasia out of which 3 (7.5%) were CIN III and 4 (10.0%) were CIN II. We also reported two cases (5%) as early invasive carcinoma cervix. Conclusion: From this study we can conclude VIA screening to be a cheap and easy OPD level procedure to rule out inflammatory conditions and diagnose CIN/Cervix malignancy and it's precursors at early stages.

   PP-004: Signet Ring Cell Morphology in Gynecological Liquid Based Cytology Specimens Top

Sudhanshu Sulania, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India

Introduction: Signet ring cell is a cell with a large cytoplasmic vacuole causing peripheral displacement of the nucleus. In the cervix it can be seen in various non-neoplastic and neoplastic conditions. Herein, we report two malignant cases of Signet ring cell morphology. Case Report: Case 1: 61 years old lady (known case of colonic carcinoma with resection and chemotherapy) presented with bleeding per vaginum (PV). LBC smear showed small clusters of signet ring cells with eccentric hyperchromatic nuclei and vacuolated cytoplasm. On immunocytochemistry (ICC), the cells were positive for ER, CK7 & Vimentin and negative for p16 & CK20. Biopsy showed features consistent with endometrial adenocarcinoma which was conformed on biopsy subsequently. Case 2: 32 years old lady (known case of Rectal Carcinoma with resection and anastomosis) presented with complaints of white discharge PV, dysuria and pain abdomen for 6 months, MRI showing infiltration into the cervix. LBC smear showed presence of signet ring cells with eccentric hyperchromatic nuclei. On ICC cells were positive for CK20, thus confirming local infiltration of Rectal Adenocarcinoma. Conclusion: Atypical Signet Ring Cells can be seen in LBC smears. Relevant ICC can help us arrive at the diagnosis.

   PP-005: A Case of Adenoid Cystic Carcinoma with Special Reference to its Differential Diagnosis with Respect to Hyaline Globules Top

Sunita Naiding, Aparna Dutta; Assam Medical College and Hospital, Dibrugarh, Assam, India

Background: Adenoid cystic carcinoma (AdCC) is a common malignancy in the minor salivary glands. Cytologically, hyaline stromal globules are the most striking feature of this neoplasm but are not diagnostic thereof. Case Report: A 52 years old male presented with swelling on the anterior aspect of the right side of the neck for 2 months. FNAC showed a cellular smear with cells arranged in clusters as well as dispersed singly. Individual cells had scant cytoplasm with high N: C ratio, nuclear moulding, round to oval hyperchromatic nuclei, coarse chromatin, inconspicuous nucleoli, and few cells adherent to a moderate amount of hyaline stroma forming globules. A diagnosis of Adenoid Cystic Carcinoma was suggested which was later confirmed by histopathological examination. Discussion: Hyaline globules are also seen in other entities such as Basal Cell Adenoma (especially the membranous and trabecular variants) but the marked variation in size and a dense, truly hyaline texture of the globules and hyperchromatic nuclei suggest AdCC. Hyaline stromal globules may be seen in pleomorphic adenoma (PA) and again the diagnosis is based on the bland nuclear features of PA. Distinction from superficial dermal neoplasms such as Cutaneous Cylindroma (pinkish basement membrane-like material surrounded by round cells) and Basal Cell carcinoma (tightly cohesive cells in cluster with a distinct edge to the group) can also be difficult. Conclusion: Due to its relatively bad prognosis, prompt FNAC diagnosis of AdCC is very beneficial to patients but the Pathologist must always be mindful of the mimics concerning Hyaline Globules.

   PP-006: A Case Report of a Lateral Ectopic Thyroid: A Cyto-Histological Picture Top

Bandana Barman, Adity Sharma; Assam Medical College and Hospital, Dibrugarh, Assam, India

Case Report: Follicular adenoma in a Lateral Ectopic Thyroid (Submandibular swelling). Background: The term ectopic thyroid refers to the presence of thyroid tissue, located at a site other than its original anatomical site and most importantly when there is no vascular connection to the main gland. Lingual thyroid is the most common ectopic thyroid presentation. Ectopic thyroid in the submandibular region is rarely found. Its incidence is 1 per 300000- 400000 and more common in females. Case Report: Here we present a case of a left submandibular swelling in a 22-year-old female who presented with a painless for 4 months. Diagnostic imaging and Fine Needle Aspiration Cytology were advised to the patient. Radiological investigations suggested multinodular goitre along with presence of thyroid tissue in neck spaces. On examination, the swelling was of size 3.5 *3 cm with well-defined margins, firm in consistency and regular border. After taking consent from the patient, FNAC was performed which revealed thyroid follicular cells and a diagnosis of Benign Follicular Nodule was made. The clinical and cytological features favor the possibility of Lateral Ectopic Thyroid Tissue. Histological examination was done later and was reported as Follicular Adenoma. Discussion: FNAC is a quick, cost-effective, and well-tolerated procedure. It is reliable to distinguish between benign and malignant lesions and helps to plan the management. Thyroid Ectopia should always be a differential diagnosis of submandibular swelling. The ectopic thyroid tissue can be an adenoma or even a carcinoma, therefore proper diagnostic tests and a management plan is necessary.

   PP-007: A Comparaive Study of Aspiration Versus Non-Aspiration Technique in Thyroid Swellings Top

Ashok Sangwaiya, Shilpa Bairwa, Pawan Singh, Puja, Bhawna Sethi, Neerav Saini

Introduction: Fine needle aspiration cytology (FNAC) is used as primary routine, minimal invasive technique to diagnose the nodular thyroid lesions. Inadequate and bloody smears obtained by FNAC may lead to its improper interpretation. To avoid this, fine needle non- aspiration cytology (FNNAC) can be performed which avoids active aspiration and depends on capillary tension to collect tissue sample in the needle bore. Aim: To compare the diagnostic importance of fine needle aspiration cytology and fine needle non- aspiration cytology technique in lesions of thyroid gland. Materials and Methods: This was a six months prospective study done in the department of pathology at Shaheed Hasan Khan Mewati, Government Medical College. The study included 261 patients who presented with a thyroid swelling. The Cytopathologist was blind folded regarding the technique used and the slides were assessed using Mair et al. scoring system. Results: In this study, FNNAC yielded diagnostically superior material than FNAC. Diagnostically adequate cases were more with FNNAC. Unsuitable diagnostic material was less in FNNAC (10.34%) as compared to FNAC (19.54%). The background clot/blood was significantly low in FNNAC than FNAC with the p value less than 0.001. Conclusion: FNNAC is a simple, easy to perform and produces better results in the form of better cellularity and less field obscurity by blood in lesions of the thyroid. This can be used alone or in tandem with FNAC for better diagnostic yield.

   PP-008: A Rare Case of Osteoclastic Variant of Anaplastic Thyroid Carcinoma Left Lobe With Squamous Cell Carcinoma of Uncertain Origin in Right Lobe Thyroid: A Case Report Top

Rakesh Kumar Gupta, Aishwarya John, Ripu Daman Arora, Mudalsha Ravina; All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

The osteoclastic like giant cell rich variant of anaplastic thyroid carcinoma (OGCRATC) is very rare, aggressive, rapidly progressive thyroid tumor characterized by presence of large number of multinucleated giant cells. Nearly half of these cases present with cervical lymph node metastasis at the time of diagnosis. Squamous cell carcinoma (SCC) in thyroid is mostly due to secondary involvement either by direct extension from the adjacent organs or because of metastasis. We report an unusual case of 55-years-old female patient having OGCRATC in the left lobe of and SCC in the right lobe with multiple musculoskeletal metastasis and cervical lymph node deposits diagnosed on fine needle aspiration cytology (FNAC). PETCT scan showed two distinct FDG avid lesions in right lobe and left lobe of thyroid. Additionally, FDG avid deposits in right sternocleidomastoid muscle, and multiple distant bony metastases. Patient was started with chemotherapy (paclitaxel and carboplatin), however, expired after receiving two cycles. FNA smears from right lobe and right cervical lymph node showed dyskeratotic cells with pyknotic nuclei and orangophilic cytoplasm and many tadpole cells suggestive of SCC. FNA smears from left lobe were richly cellular showed sheets, papillaroid, as well as cohesive clusters with plenty of multinucleated (osteoclast like) giant cells. Many large bizarre cells and frequent mitotic figures were noted. This is a unique first case of OGCRATC, left lobe with multiple distant bony metastases similar to follicular carcinoma with an associated distinct lesion of SCC of uncertain origin in the right lobe.

   PP-009: Primary Tubercular Infection of Thyroid Gland: Is it so Rare? Top

N K Bariar, Patna Medical College and Hospital, Patna, Bihar, India

Objective: Thyroid gland has a high resistance to infection because of factors like abundant lymphatic network, high vascular supply, well-developed capsule, high iodine content of the gland, and bactericidal effect of the colloid and iodine so this rare entity is discussed in this paper. Case Report: A 15-year-old male presented with the history of painless, gradually progressive neck swelling for past 6 months. There was no history of cough, fever, night sweating, malaise, loss of appetite, or loss of weight. There was no past or family history of tuberculosis. Clinically there was neck swelling which moves with deglutition. Chest X-ray was normal. Other biochemical investigations including thyroid function tests were also within normal limits. Fine needle aspiration smears revealed many epithelioid cell granulomas admixed with thyroid follicular epithelial cells. Stain for acid fast bacilli was positive, confirming the diagnosis of tubercular thyroid. Mantoux test was also positive. Imaging also revealed enlarged thyroid. The patient was kept on anti-tubercular treatment to which the patient responded well. Within one month the swelling decreased and the patient was feeling better. Conclusion: Fine needle aspiration cytology (FNAC), proves to be quick and effective tool in the diagnosis and management of the patients of thyroid tuberculosis as these were subjected to biopsy before the advent of this technique.

   PP-010: Aliens in the Thyroid Gland: The Secondary Lesions Top

Aishwarya Sharma, Sankalp Sancheti, Akash Sali, Puneet Somal

Introduction: Secondary lesions in the thyroid gland are rare and often pose a diagnostic challenge in cytology samples. Clinical history, imaging findings and ancillary techniques are useful for recognizing these lesions in difficult cases. Aim: To assess the secondary lesions in the thyroid gland. Materials and Methods: A 6-year retrospective review (2016-21) was carried out to assess the secondary lesions in the thyroid gland. Papanicolaou and field-stained smears were reviewed. Ancillary techniques were performed on the cell block for differentiating from the primary thyroid gland lesions. Results: There were 383 thyroid fine needle aspiration cytology (FNAC) cases in our archives. Out of these, there were 338 in-house hospital registered cases, and 45 cases were outside samples that were received for review. There were only 18 cases (4.7%) that presented with secondary neoplastic lesions in the thyroid gland either by direct extension, metastases or as a hematolymphoid malignancy. There were 14 (77.7%) cases that presented with non-hematolymphoid secondary lesions while 4 (22.3%) cases presented with hematolymphoid malignancies. Squamous cell carcinoma (12/18) was the commonest secondary lesion locally infiltrating into the thyroid gland in most cases (8/18) or presented as metastasis (4/18). Metastasis of the lung (1/18) and breast adenocarcinoma (1/18) was also detected. Amongst the hematolymphoid malignancies, diffuse large B cell lymphoma was detected in 2 cases, Plasma cell neoplasm and B cell lymphoma in 1 case. Conclusion: Although exceedingly rare, the detection of secondary thyroid gland lesions is important for staging and planning treatment.

   PP-011: Anaplastic Thyroid Carcinoma – A Case Series From a Tertiary Care Centre of North East India Top

Kuladeep Thakuria, Junu Devi; Gauhati Medical College and Hospital, Guwahati, Assam, India

Background: Anaplastic thyroid carcinoma is a rare, highly aggressive malignant tumor accounting for 2 to 3 percent of all thyroid gland neoplasms. It continues to be one of the most deadly diseases worldwide carrying a very poor prognosis. Patients usually present with rapidly growing painless anterior neck mass with dyspnea. In addition to considerable local invasion, it often presents with metastatic spread to regional lymph nodes. It accounts for more than half of the deaths for thyroid cancer, with a mortality rate over 90%. Methods: In this case series, three cases of anterior neck swelling which were rapidly growing in size that underwent fine needle aspiration cytology during the last one year in the Department of Pathology, Gauhati Medical College and Hospital, Guwahati were analyzed with respect to age, sex, clinical and cytomorphological findings. Results: All the three cases were diagnosed as Anaplastic Carcinoma of Thyroid based on cytomorphological features on FNA smears, one patient was male and two were female. Age range of the patients was 60-70 years. All the three cases presented as rapidly growing neck swelling of 6-8 months duration. Dyspnea were a common presentation in all the three cases. Conclusion: Even though anaplastic thyroid carcinoma is a very rare thyroid cancer, the condition usually presents at a very late stage and is associated with significant morbidity and mortality. Hence, early detection aids in planning management strategies for better and longer survival outcomes in these patients.

   PP-012: Cell Block to the Aid in the Diagnosis of a Rare Case of Metastatic Paraganglioma – A Definitive Way Out Top

Swati Nayek, Shreosee Roy, Debarati Pathak, Anup Kumar Boler

Paragangliomas are neural crest derived neoplasms most commonly arising in head and neck region and upper thorax. Head and neck paragangliomas are generally considered to be benign tumors but rarely, about 5% produce metastasis. We report a case of a 41 year old male presenting with left sided pulsatile neck mass along with a right sided lytic rib lesion as detected by CT scan. Fine needle aspirations from both the lesions showed similar cytomorphology of loose clusters of round to ovoid cells having granular cytoplasm, indistinct borders and occasional anisokaryosis. The differentials were metastatic paraganglioma and metastatic follicular carcinoma of thyroid. Surgical excision of the neck lesion followed by histology revealed it to be paraganglioma. Subsequently immunohistochemistry study on cell block prepared from aspirate of the rib lesion showed strong positivity for Chromogranin A, thus implying it to be metastatic paraganglioma. We present this case to depict the picture of a rare entity (metastatic paraganglioma) where cell block study with immunohistochemistry came to the aid in diagnosing a lesion that was difficult to sample surgically.

   PP-013: Colloid Goitre with Microfilaria Infestation – A Rare Coincidental Finding Top

Rachit Batra, Anjana Arya, Mithila Bisht, Divya Bajpai; Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India

Introduction: Microfilaria refers to the embryonal stage of a parasitic worm known as filariae. These parasitic nematodes belongs to the family Filarioidea. In India, filariasis is mainly cause by parasites of mainly two species of nematodes including Wuchereria bancrofti and Brugia malayi. Filariasis is an established public health problem in India with about 31 million people harbouring microfilaria. Microfilaria is highly endemic in areas of Bihar, Kerala and Uttar Pradesh. Microfilariasis is usually diagnosed by demonstrating the parasite in the peripheral blood smears. Detection of microfilaria in the fine needle aspiration cytology smears of thyroid is unusual. Case Report: A 23 year old female patient presented with complaints of midline neck swelling since 6 months. On clinical examination, an ill-defined solitary swelling of size 3 x 3 cm was found which moved with deglutition. The swelling was cystic and non-tender. On ultrasonography, a diagnosis of colloid nodule was given. On FNAC, macrofollicles, dispersed follicular cells, macrophages and multiple microfilarias were seen in a background of thin colloid. Conclusion: We present a rare coincidental finding of microfilaria infestation in a case of colloid goitre which was found during fine needle aspiration cytology of a thyroid nodule, thus emphasising the need to look for parasites on fine needle aspiration cytology.

   PP-014: Comparative Analysis of Liquid-Based Cytology and Conventional Preparation in Fine Needle Aspirate Specimens of Salivary Gland Lesions Top

Sant Prakash Kataria, Garvita, Sanjay Kumar, Mahak, Sunita Singh, Pt. B D Sharma; Pt. B D Sharma PGIMS, Rohtak, Haryana, India

Background: Fine needle aspiration is a useful triage tool to assess the salivary gland lesions which distinguishes neoplastic lesions from non-neoplastic lesions. Liquid-based cytology is an alternative processing method which is used for both gynecological and non- gynecological smears. Aim of the present study was to determine the diagnostic efficacy of Liquid based cytology (LBC) in salivary gland lesions and to compare the results with those of conventional preparation. Materials and Methods: A Prospective study was conducted in the department of pathology, PGIMS Rohtak over a period of three years, which included a total of 50 salivary gland lesions. All the lesions were categorized according to the Milan system of reporting salivary gland cytopathology. Histopathological correlation was done in the all the available cases. Results: Out of these 50 lesions, 23 lesions were benign, 13-malignant, 9- inflammatory, 3- cystic lesions and 2-suspicious of malignancy. Pleomorphic adenoma was the most common benign lesion diagnosed on both CP and LBC followed by Warthin's tumor, while Mucoepidermoid carcinoma was the most common malignant lesion diagnosed followed by adenoid cystic carcinoma and adenocarcinoma (NOS). Twelve cases of pleomorphic adenoma, 3 Warthin's tumor and 2 mucoepidermoid carcinoma were correctly diagnosed on CP and LBC preparation, while 4 cases of chronic sialadenitis diagnosed on CP were not diagnosed on LBC preparation. Conclusion: LBC is relatively simple technique which results in better nuclear and cytoplasmic details with loss of background blood and debris. However, the use of both LBC and CP are recommended to achieve the optimal diagnostic results.

   PP-015: Comparative Evaluation of Conventional Smear and Liquid Based Cytology in Diagnosis of Thyroid Lesions Using Bethesda System Top

Sumiti Gupta, Ajay Kumar, Renuka Verma, Rajnish Kalra, Ritu, Sunita Singh; PGIMS, Rohtak, Haryana, India

Introduction: The prevalence of palpable thyroid nodules in the worldwide population ranges from 4 to 7%. Approximately 95% of these lesions are benign and thyroid cancer is responsible for only 0.4% of all cancer deaths. The Bethesda system for reporting thyroid cytology allows standardization in reporting with improved diagnostic terminology between cytopathologists and clinicians, and leads to more consistent management approaches. Materials and Methods: 60 cases with palpable thyroid lesions were considered. After detailed history, clinical examination and informed consent of patient, FNA of thyroid lesion was performed. Comparative study of Conventional smear (CS) and Liquid based cytology (LBC) was done using a standardized nomenclature by Bethesda system. The results were correlated with clinico-imaging diagnosis and histopathology wherever possible. Results: LBC smears contained adequate diagnostic cells in most cases and were greatly superior to CS regarding the absence of background blood-debris, and recognition of nuclear and cytoplasmic details (p<0.001). LBC showed cellularity, preserved cell architecture, and informative background as good as CS, expressed by no statistically significant differences (p=0.297, 0.083, and 1.000 respectively). In LBC amount of colloid was diminished and appear dense, fragmented, and in droplets. Conclusion: LBC is a relatively simple technique; reducing the number of slides and area per slide to be screened than CS. However, caution must be applied to interpret the slides and secure a diagnosis, especially if the LBC is the first and only method applied as adequate experience is required to familiarize with various lesions on LBC.

   PP-016: Composite Thyroid Tumour (Papillary Carcinoma and Medullary Thyroid Carcinoma): A Case Report Top

Nani Gopal Reang, AGMC and GBP Hospital, Agartala, Tripura, India

Background: Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy and medullary carcinoma of thyroid is the third most common type of thyroid carcinoma. The composite papillary and medullary carcinoma is exceedingly rare. There have been fewer than 40 cases reported in the literature. Case Description: A 56 years old women with multinodular thyroid swelling and soft tissue mass in the scapular region. The FNAC from both the thyroid and soft tissue mass show features of follicular neoplasm of thyroid with soft tissue metastasis. Subsequently total thyroidectomy was done which on microscopy reflects the features of composite thyroid tumor (papillary carcinoma of thyroid and medullary carcinoma of thyroid). Conclusion: It is important to report this case to increase awareness about the possibility of a composite thyroid tumor and improve our understanding and management of this unusual carcinoma in future.

   PP-017: Cytohistological Correlation and Evaluation of the Milan System for Risk of Malignancy in Salivary Gland Cytology; A Single-Institutional Prospective Study Top

Anurag Gupta, Subrat Chandra, Pradyumn Singh, Nidhi Anand; Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Introduction: Cytology plays an important role in deciding the management plan of salivary gland lesions. The objective of the present study was to evaluate the diagnostic efficacy and utility of the recently introduced Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Methodology: The study was carried out from January 2018 to December 2020. 192 salivary glands FNA were performed, with histology follow-up available for 73 cases (38.1%). The diagnoses were categorized using MSRSGC as non-diagnostic (category I); non-neoplastic (category II); atypia of undetermined significance (AUS) (category III); benign neoplasms (category IVA); salivary gland neoplasm of uncertain malignant potential (SUMP) (category IVB); suspicious for malignancy (SFM) (category V); and malignant (category VI). The risk of malignancy (ROM) for each diagnostic category was determined. The performance parameters and ROM were calculated with histopathology as the gold standard. Results: The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of salivary gland FNA specimens were 96.4%, 91.9%, 91.9%, and 90%, respectively. The ROM/overall ROM (with total cytology cases as a denominator for each Milan category) for non-neoplastic, AUS, benign neoplasms, SUMP, SFM and malignant were 0/0%, 25/20%, 9.1/3.9%, 75/27.3%, 66.6/50%, and 100/58.1 respectively. The ROM for the non-diagnostic category could not be calculated. Discussion and Conclusions: In our study, MSRSGC showed high PPV and NPV, hence, assisting in better communication between the cytopathologist and clinician for optimum patient care. The ROM for each Milan category reported in our institution was within the ranges reported in other studies.

   PP-018: Cytological Features of Extra Nodal Natural Killer/T-Cell Lymphoma (Enktl), Nasal Type – Report of Two Cases Top

Sumaira Qayoom, Mala Sagar, Geeta Yadav, Veerender Verma, Vijay Kumar; King Georges Medical University, Lucknow, Uttar Pradesh, India

Background: Extranodal natural killer/T cell lymphoma, nasal type is relatively rare aggressive extranodal lymphoma of NK cell or T cell lineage. Literature on cytology of ENKTL is limited. We hereby, report two cases of ENKTL diagnosed on cytology and later on confirmed by histopathology and Immunohistochemistry. Case Report: Case 1: A 69-year female presented with nasal swelling and pus discharge for the last 4 months. On examination, an ulcerated lesion was seen on nose. There was no lymphadenopathy. Case 2: A 14-year-old female presented with nasal cavity mass and difficulty in breathing and a non-healing skin ulcer for the last month. On examination, ill-defined nasal swelling and an ulcerated skin lesion was identified on abdominal wall. There was no lymphadenopathy. Cytology smears from the nasal mass of both the cases were hypercellular, composed of medium to large atypical lymphoid cells with folded nuclei, irregular nuclear membrane, and some cells with prominent nucleoli. The cytoplasmic tongue was seen in many cells and azurophilic granules in occasional cells. Diagnosis of ENKTL was rendered, however, a biopsy was recommended to confirm the cytological diagnosis. On histopathology, atypical lymphoid cells with irregular nuclear contours and scant cytoplasm were seen. Brisk mitosis and angioinvasion were also noted. Cells were positive for CD3, CD56, Granzyme and negative for P40, Desmin, Synaptophysin and pan -CK. Hence, a diagnosis of ENKTL was rendered. Conclusion: Awareness of cytological features of ENKTL can help in making FNAC a reliable diagnostic modality for primary diagnosis and in the recurrence of ENKTL.

   PP-019: Cytology of Secretory Carcinoma of Salivary Gland: A Series of Three Cases Top

Subrat Chandra, Anurag Gupta, Pradyumn Singh; Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Introduction: Secretory carcinoma (SC) is a recently described salivary gland tumour that shares the same histologic appearance and ETV6-NTRK3 gene fusion as secretory carcinoma of the breast. Only a few cases have been reported in the literature that describe the cytological features of SC. Here, we present a series of 3 cases of SC. Case Report: Case-1 was 70 years male with right parotid mass, case-2 was 21 years female and case-3 was 19 years male, both presented with recurrent left parotid masses. Case-1 was mistaken as a Warthin tumour on cytology due to lymphocyte-rich background. Smears of case-1 were reevaluated with two subsequent cases and were diagnosed as SC on cytology with positive immunocytochemistry for mammaglobin and S100 protein. In the above cases, FNAC smears were cellular and exhibited many loosely cohesive clusters of oncocytoid cells along with a fair number of histiocytes and proteinaceous material in the background. Tumour cells exhibited vacuolated cytoplasm with uniform nuclei showing single prominent nucleoli. A fair number of lymphocytes were noticed in case 1. Discussion: The absence of intracytoplasmic zymogen granules favours SC over classical acinic cell carcinoma. SC should also be cytologically distinguished from other benign and low-grade salivary gland tumours accompanied by mucinous background. IHC on cell block is another way to differentiate SC from mimickers. Conclusion: The above cases shared the cytological features of SC described in previous literature. However, the proteinaceous background was a consistent finding in all three cases.

   PP-020: Facial Skeletal Metastasis of Follicular Thyroid Carcinoma – An Unusual Presentation Top

Sunakshi, Rachana Meena, Preeti Diwaker, Anupama Tandon; University College of Medical Sciences, New Delhi, India

Introduction: Follicular thyroid carcinoma (FTC) accounts for 6-10% of thyroid malignancies. Higher incidence in females aged 40 to 60 years. Distant metastasis is seen in 10-15 % cases with lungs as most common site followed by bones. FTC metastases to the facial bone are exceedingly rare and pose a diagnostic dilemma. Herein we present a rare case. Case Report: A 30 year old lady presented to OPD with complaint of swelling of anterior neck for 6 months and angle of jaw for 4 months. On examination, neck and jaw swellings were 6x5 cm and 8x8 cm respectively, well defined and hard. FNAC was advised. Cytological smears from both the sites were hypercellular comprising of follicular epithelial cells arranged in monolayered sheets, repetitive microfollicles with no colloid in the background. No nuclear features of Papillary thyroid carcinoma were seen. Diagnosis of Suspicious for follicular neoplasms with metastasis to submandibular region was made and CT neck advised. NCCT, neck showed evidence of nodular enlargement of left lobe of thyroid gland extending into tracheoesophageal groove, trachea alongwith lytic, destructive lesions involving hemimandible and alveolar ridge. Multiple nodules in bilateral lungs with mass involving right pleura causing erosion of 3rd & 2nd rib and lytic lesions in T4 vertebrae were seen. Patient was referred to Delhi State Cancer Institute for further management. Discussion: Facial skeleton metastasis is seen in 2-8% of thyroid carcinomas with 10 year survival rate of 27%. This case highlights the importance of FNAC in early detection of metastasis to facial skeleton.

   PP-021: Fine Needle Aspiration Cytology of Ameloblastoma: A Case Report Top

Abu Yusuf Md Khairuzzaman, Junu Devi; Gauhati Medical College and Hospital, Guwahati, Assam, India

Background: Ameloblastoma is a benign locally aggressive odontogenic tumour commonly occurs in jaws. It accounts for 1% of all tumours and cyst of jaw. It is mostly occurs in the age group 30 – 60 years, with equal sex distribution. FNAC diagnosis of ameloblastoma is rare. It is also rare in children. Here we describe a case of acanthomatous ameloblastoma in a 11 years old child diagnosed by FNAC. Case Report: A 11 years old male presented with a left sided jaw mass in the ENT OPD of Gauhati medical college with mild pain. It was 4*3 cm in size since 1 year. Radiologically it showed expansile, soap bubble lesion with well demarketed borders and no matrix calcification. Fine needle aspiration cytology showed benign basaloid epithelial cells in sheets and clusters with focal peripheral palisading. A cytological diagnosis of ameloblastoma was done. Histological examination of the resected specimen confirmed the cytological diagnosis. Conclusion: FNA is a valuable technique for preoperative diagnosis of jaw tumour as preoperative biopsy is traumatic. Since ameloblastoma is locally aggressive and it has very high recurrence rate wide local excision can be planned with the help of preoperative cytology report.

   PP-022: Fine Needle Aspiration Cytology of SMARCA4 (BRG1) - Deficient Sinonasal Teratocarcinosarcoma: First Report in Literature Top


Introduction: Inactivating mutations of SMARCA4, which encodes BRG1 protein, were recently identified in a subset of sinonasal poorly/undifferentiated carcinomas with neuroendocrine differentiation and teratocarcinosarcomas (TCS). Less than 50 cases of SMARCA4-deficient sinonasal carcinomas have been described, and there is no report of their cytological features. Case Report: A 22-year-old male was diagnosed to have SMARCA4-deficient TCS on a nasal mass biopsy, and started on neoadjuvant chemotherapy (NACT). Four months later, fine needle aspiration cytology (FNAC) from level Ib cervical lymph node showed a cellular tumor with loosely cohesive round to ovoid cells with nuclei having stippled chromatin. After completion of NACT, FNAC from level II lymph node showed predominantly discohesive tumor cells with moderate to abundant cytoplasm and enlarged vesicular nuclei with prominent nucleoli. Few ovoid to spindled cells were present. Frequent mitoses, apoptosis, nuclear streaking and a pseudo-tigroid background were evident. Occasional cohesive fragments showed tumor cells attached to fibrovascular cores. Overt squamous or glandular differentiation was absent. Tumor cells showed loss of BRG1 immunostaining, and beta- catenin immunopositivity on cell block, consistent with metastatic SMARCA4-deficient TCS. Conclusion: SMARCA4-deficient TCS are aggressive tumors with propensity for nodal metastasis, presenting opportunities for FNAC diagnosis. The diversity of cell types results in a broad spectrum of cytological features that overlap with that of other regional metastatic tumors including neuroendocrine carcinoma, olfactory neuroblastoma and melanoma. Thus, SMARCA4-deficient carcinomas should be considered in the differential diagnosis of metastatic poorly/undifferentiated malignancies in cervical lymph node aspirates, and appropriate ancillary tests employed for accurate diagnosis.

   PP-023: Hashimoto'S Thyroiditis Mimicking Papillary Thyroid Carcinoma – False Positive Cytology with Histopathological Correlation Top

Mithun Chandra Das, Junu Devi; Guahati Medical College, Guwahati, Assam, India

Background: Hashimoto's thyroiditis an autoimmune disease can be so extensive may mimic as papillary thyroid carcinoma because it may causes massive destruction of thyroid gland and may show similar nuclear atypia like PTC. One of the reason for positive cytological finding and negative histological finding of papillary thyroid carcinoma is false positive diagnosis. Case Report: A 35 year lady came to ENT OPD of GMCH with a chief complaint of midline swelling for one year. She give history of mild pain in the neck. There was a history of mild weight los. Her menstrual history was regular. On general examination pallor was present. On local examination diffuse neck swelling of size 4x3 cm2 noted with a firm consistency. Her thyroid profile was within normal limit. After FNAC preoperative cytological diagnosis malignancy suggestive of papillary thyroid carcinoma (category VI) according to Bethesda system. After the thyroidectomy operation surgical specimen was extensively grossed for histopathological correlation and it was diagnosed as Hashimoto's thyroiditis. Conclusion: Although cytological findings of this thyroid disease strikingly similar to that of a thyroid neoplasm the final diagnosis pointed towards histopathological examination. As this type of thyroiditis could manifest as thyroid neoplasm, hence histomorphology in conjunction with biochemical findings are necessary for confirmed diagnosis and to reduce false positive rate.

   PP-024: Lateral Neck Mass; Aberrant Ectopic Thyroid Malignancy: A Case Report Top

Bhavya Singh, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India

Background: Lateral aberrant ectopic thyroid is extremely rare, comprising only 1-3% of all the ectopic thyroid tissue. Primary carcinoma in lateral aberrant ectopic thyroid with normal active native thyroid is very uncommon. Clinically these lesions are mistaken for lymph node swelling or metastatic tumor. Case Presentation: A 25 yrs old female patient came to the pathology department, JLNMC Bhagalpur for cytological evaluation of neck swelling. The patient complained of having noticed the neck swelling for past 8 months but with abrupt increase in size for the last 1 month. On examination the swelling on left lateral cervical region (approx. 2x3 cm, soft to firm in consistency) did not show any movement on deglutination whereas the midline swelling (approx. 1x1 cm, soft to firm in consistency) showed movement on deglutination. On cytological examination, the left lateral swelling was reported as papillary carcinoma of thyroid as the smear showed cellular aspirate with sheets of cells arranged in papillary architecture having overlapping nuclei with intranuclear inclusions, nuclear groove and fine chromatin whereas the midline swelling was reported as normal eutopic thyroid with no features of malignancy. In toto excision of lateral cervical mass along with subtotal thyroidectomy was performed. Histology of the mass revealed PTC while the thyroid gland did not show evidence of malignancy. Conclusion: Ectopic thyroid tissue in rare locations may lead to diagnostic and therapeautic dilemmas.

   PP-025: Occult Follicular Thyroid Carcinoma Presenting as Pyramidal Calvarial Mass Top

Yukim Dong, Neha Bhardwaj, Manish Rohilla, Radhika Srinivasan, Treshita Dey, Nagarjun Ballari, Harmandeep Singh

Background: Follicular thyroid carcinoma (FTC) is a malignant well-differentiated follicular cell-derived neoplasm with prominent hematogenous spread. Metastases may be the presenting symptom, especially in patients with occult metastases at diagnosis; however scalp metastasis is relatively uncommon. Case Report: A 66-year-old female presented with gradually progressive scalp swelling since 4 years. She had recent onset bilateral lower limb weakness with bladder and bowel incontinence which led her to seek neurological assistance. On examination, there was a large, soft, painless parietal scalp swelling measuring 10 x10 cm with subdural extension on contrast-enhanced magnetic resonance imaging (CE-MRI) explaining her symptomatology. Fine needle aspiration cytology (FNAC) was performed and smears were cellular showing microfollicular arrangement of uniform tumor cells. On probing, she gave a history of long- standing goiter since adolescence. The cell block histomorphology confirmed similar findings and a diagnosis of metastatic follicular thyroid carcinoma (FTC) was considered. Immunocytochemistry was performed with diffuse positivity for pancytokeratin, PAX 8, and thyroglobulin confirming the diagnosis of metastatic FTC. FDG- avid lesions in the right lobe of thyroid, cervical and mediastinal lymph nodes with multiple skeletal lesions were seen on Positron emission tomography-computed tomography (PET- CT) done subsequently. The patient refused surgery and received palliative radiation with radioactive iodine I-131. Owing to poor treatment response and extensive disease, she died within 6 months of diagnosis. Conclusion: The index case highlights the utility of FNAC for the diagnosis of occult metastatic thyroid carcinoma. The application of immunocytochemistry on cell blocks is changing the norms for diagnosing carcinomas with unknown primary.

   PP-026: Orofacial Cysticercosis – A Rare Case Report Top

Mithila Bisht, Anjana Arya, Nitesh Mohan; Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India

Introduction: Cysticercosis is a parasitic tissue infection caused by ingestion of eggs of taenia solium. It is endemic and clinically relevant in developing country like ours. Cysticercosis in the oral and perioral region is rare, incidence being 4.1%. Case Report: A 7 year old boy visited the ENT opd with a 1 cm X 1 cm swelling in the right cheek region since 1 year. The swelling was fluctuant, tender since 3 days, mobile. A provisional clinical diagnosis of sebaceous cyst was made and patient was sent for FNAC which yielded pus like material. Smears showed few anucleated squamous cells, degenerated cells, hooklets of cysticercus, crystals over a proteinaceous background. Serology done confirmed cysticercosis. Later swelling was sent for histopathology, which did not show the presence of hooklets or scolices but there was necrosis, dense eosinophilic infiltration and giant cell reaction. Absolute eosinophil count was raised to 1481. Conclusion: This case of rare occurence emphasizes the importance of careful screening in cases of facial swellings. Cysticercosis should be kept in the differential diagnosis of orofacial painless nodular swellings especially in the endemic regions.

   PP-027: Papillary Thyroid Carcinoma with Nodular Fasciitis-Like Stroma: A Rare Variant Top

Vandana Raphael, Gauranga Handique, Yookarin Khonglah, Biswajit dey, Evarisalin Marbaniang, Jaya Mishra; North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India

Papillary thyroid carcinoma (PTC) with nodular fasciitis like stroma (PTC-NFS) or PTC with fibromatosis-like stroma (PTC-FMS) is a rare variant of PTC that accounts for only 0.17%-0.5% of all cases. It is characterized as a biphasic tumor comprising extensive proliferating myofibroblastic stroma and PTC component in varying proportions. A 36-year-old female presented with a midline swelling in her neck with a gradual increase in size in the last 3 months. Thyroid function tests were within normal range. Ultrasonography revealed thyroid nodule of the left lobe with heterogeneous echotexture. The fine-needle aspirate yielded blood stained material which were stained with Giemsa and Papanicolaou stain. Microscopic examination showed cellular smears consisting of neoplastic follicular cells arranged in laminated monolayers, 3-D clusters and papillary fragments. The tumor cells showed scant to moderate cytoplasm, enlarged ovoid to round nuclei, granular powdery chromatin with nuclear crowding/ overlapping at places and intra- nuclear cytoplasmic inclusion in some cells. A prominent stromal fragments were noted in the background with some in close contact with the epithelial groups. The stromal fragments were irregularly shaped composed of bland spindle cells with extracellular matrix. The diagnosis of Bethesada category VI (Malignant) lesion with possibility of papillary carcinoma with nodular fasciitis like stroma was suggested. The histopathological diagnosis in the total thyroidectomy specimen confirmed the diagnosis. We report this rare case as this variant may be confused with mesenchymal tumors. Immunohistochemical staining using the antibody for beta-catenin is useful in diagnosis.

   PP-028: Primary Hydatid Cyst of the Neck – A Unique Presentation Top

Saudamini Agarwal, Nitesh Mohan, Anjana Arya, Mithila Bisht, Vibhuti Goyal; Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India

Introduction: Hydatid disease, or Echinococcosis, is a zoonotic infection caused by the larval stage of the cestode Echinococcus. The liver and lungs are the most frequently involved organs. Primary hydatid disease of the soft tissue is rare, and involvement of the cervicofacial region is even rarer, even in countries where the disease is endemic, with an incidence of 1%. Case Report: A 25-year-old male presented with a slow-growing painless swelling on the left side of the neck for 8-10 months. The swelling measured 6x8 cm and was soft to firm in consistency. Fine needle aspiration yielded clear fluid, and smears prepared from the aspirate demonstrated refractile structures, suggestive of larval hooklets and scolex, along with a mixed inflammatory infiltrate. Subsequently performed ultrasonography of the neck revealed a thick-walled cystic lesion with internal septations and echoes, in the subcutaneous plane. The findings of ultrasonography along with the presence of larval structures on cytomorphological examination confirmed the diagnosis of hydatid disease. Conclusion/Summary: The occurrence of primary hydatid disease in the neck is rare, and the diagnosis is, therefore, often overlooked when dealing with neck swellings. The case signifies that clinicians must bear in mind hydatid disease in the differential diagnosis of well-defined cystic lesions of the cervicofacial region, especially in areas where the disease is endemic. Although discouraged as a diagnostic tool in suspected cases of hydatid disease for the risk of anaphylaxis, the case also highlights the importance of fine needle aspiration cytology in cases where clinical suspicion is lacking.

   PP-029: Primary Orbital Marginal Zone B Cell Non-Hodgkin'S Lymphoma – A Rare Case Report. Top

D S Vellikal, N Sahu, R Giri, G DasNayak, P Pradhan, U Senapati, D R Satpathy; Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India

Introduction: Orbital lymphomas account for 1%–2% of Non-Hodgkin's lymphomas (NHL) and 2%–11% of orbital tumors. The most common primary orbital lymphoma is the low grade marginal zone B cell lymphoma. 75% of the orbital lymphomas are primary without any systemic involvement. Here we present a case of primary orbital NHL diagnosed on biopsy. Case Report: A 67-year old male, presented with swollen right eye associated with lacrimation since 2 months. On examination there was right eye proptosis. Thyroid, liver and renal function tests were within normal limits. CECT revealed a homogenously enhancing intraconal mass of size 4.1x3.2x2.8 cm with features favouring benign etiology. Observations: Cytological evaluation revealed polymorphous population of lymphoid cells in various stages of maturation. No epithelioid cells were seen; suggestive of inflammatory pseudotumor of orbit. Histopathological findings were suggestive of small cell NHL. Immunohistochemistry showed positivity for CD20, CD79a, PAX5 and Bcl2 and negative for CD3 CD5, CD10, CD23, Bcl– 6, Cyclin-D1. Hence a final diagnosis of marginal zone B cell lymphoma was rendered. Detailed clinical and radiological evaluation did not reveal lymphadenopathy anywhere else. Conclusion: Orbital lymphomas can be confused as reactive lesion on radiology and cytology. As most of the primary orbital lymphoma develop systemic disease, regular follow up is essential. This case highlights the diagnostic dilemma posed by low grade NHL mimicking as inflammatory pseudotumor.

   PP-030: Resolving Hot Potatoes by Intra-Oral Fine Needle Aspiration Cytology of Tonsillar Mass Top

K Abhilash Krishnan, Neha Bhardwaj, Manish Rohilla, Radhika Srinivasan, Pankaj Malhotra

Background: Primary tonsillar lymphoma accounts for <1% of head and neck malignancies. Combined chemotherapy and radiation therapy is highly effective and an early diagnosis is crucial for successful outcome. Case Report: A 51-year-old male o presented with foreign body sensation with difficulty in deglutination and weight loss since 4 months. On examination, there was typical “hot potato voice” with grade 4 right tonsillar enlargement. Contrast-enhanced CT scan revealed an ill- defined heterogeneously enhancing lobulated polypoidal lesion involving right palatine tonsil, tonsillar pillars, tonsillolingualsulcus and posterolateral oropharyngeal wall causing severe luminal narrowing of the oropharyngeal airway. Intra-oral Fine needle aspiration (FNA) was performed from the mass and sample collected for flow-cytometric immunophenotyping (FCI) and cell block. The smears were highly cellular and show dispersed population of atypical lymphoid cells with morphology of high-grade lymphoma. FCI of CD45+ gated cells revealed 90% CD19+ B cells with kappa light chain restriction along with positivity for CD20, CD43, CD10, CD38, FMC7, HLADR and surface IgM expression; CD23, CD200, CD5 and CD34 were negative. Cell block also confirmed the diagnosis of Diffuse Large B-cell Lymphoma of Germinal centre phenotype. No biopsy was taken in view of risk of bleeding in an obstructed airway and the patient managed as per the FNA report with CHOP-R chemotherapy. There was complete regression of symptoms and voice restoration. Conclusion: The case highlights the powerful role of FNAC with FCI and cell block immunocytochemistry that can provide a rapid and accurate diagnosis of lymphoma as per WHO classification enabling prompt management.

   PP-031: Secretory Carcinoma (Mammary Analogue Secretory Carcinoma) Rare Diagnosis on Aspiration Cytologic Smears and Cell Block: A Case Report Top

Abhishek Malik, Jyotsna Naresh Bharti; AIIMS, Jodhpur, Rajasthan, India

Background: Rare primary salivary gland tumor that harbors specific ETV6 genetic rearrangement, most commonly ETV6-NTRK3 translocation t (12;15). Predominantly occurs in parotid gland, minor salivary glands of oral cavity and submandibular gland. The first description of mammary analogue secretory carcinoma (MASC) was published by Skalova et al. in 2010. Case Report: A 46 year old male presented on FNAC clinic with left parotid region superficial swelling measuring 5 x 5 cm with no ulceration on the overlying skin. The swelling gradually increased in size over course of 1.5 years with no associated symptoms. FNA yielded blood mixed aspirate. Microscopic Examination of aspirate revealed cellular smears and singly scattered and sheets of epithelial tumor cells. These tumor cells moderate to abundant cytoplasm few showing vacoulations with minimal anisonucleosis, round nuclei, regular nuclear contour, fine chromatin and punctate nucleoli. With no necrosis seen in the smears examined. Immunohistochemistry was performed on the cell block preparations. The tumour cells were immunoreactive for S100P, Cam 5.2 and GATA-3 and negative for p63, CD 10, AR, DOG1 and CD 117. A final diagnosis of secretory carcinoma was suggested. Conclusion: Secretory carcinoma is a rare entity as these carcinomas are clinically and radiologically indistinguishable from other salivary gland tumours and as therapeutic approaches and prognosis might differ, we need to be able to diagnose MASC correctly and imperative to keep it in the differential diagnosis of malignant low-grade salivary gland tumors and FNA can be useful in preoperative diagnosis.

   PP-032: Sialolipoma: Rare Benign Neoplasm of Salivary Gland Top

Rohit Singh, Madhu Kumar, Mala Sagar; King George's Medical College, Lucknow, Uttar Pradesh, India

Introduction: Sialolipoma is a rare benign tumor found within both major and minor salivary gland. Lipomatous neoplasms of the parotid gland are rare tumors contributing from 0.6% to 4.4% to all parotid neoplasms with most series reporting an incidence of 1%. It is extremely rare in females, being 10 times more common in males, and the most common age of presentation is the five to sixth decade. We report rare case of sialolipoma on the basis of histopathology &Immunohistochemistry. Materials and Methods: A 46-year female presented with chief complain of swelling over left parotid region since 6 year which was gradually progressive in size and associated with pain from 4 months. On examination, well defined, soft to cystic mass measuring 3.0 x 2.5 cm was palpated over parotid region which was mobile and nontender. CT Scan showed well define isodense to hypodense lesion in superior lobe of left parotid region. Clinicoradiological diagnosis was pleomorphic adenoma. Results: FNAC was performed and smears were stained with Giemsa and H&E. On cytomorphology smear were cellular displaying mature adipocyte admixed with benign ductal and acinar cells. Cytological diagnosis was sialolipoma. Biopsy specimen also received. Histomorphology &Immunohistochemistry confirms the diagnosis of sialolipoma. Conclusion: Fine needle aspiration can be a helpful in narrowing the differential diagnosis like lipomatosis, sialolipoma, warthin tumor and pleomorphic adenoma. The possibility of lipomatous lesion of the parotid including a rare histopathological variant like sialolipoma should be suspected when the CT scan shows well-circumscribed clearly defined mass lesion within the parotid gland.

   PP-033: Squamous Cell Carcinoma of Oral Cavity Presenting with Metastatic Pleural Fluid Effusion Top

Arvind Kumar, Pranoy Paul; AIIMS, Rishikesh, Uttarakhand, India

Introduction: Distant metastases from the oral cavity are a rare occurrence. The most common sites for metastasis are the lung, liver, brain, and bone. Regional spread to cervical lymph nodes is common and seen in up to 40% of patients. However distant metastasis is a much rarer phenomenon in oral cavity cancers, and it's postulated that these tumours spread via hematogenous route cytopathological examination has a pivotal role in the management and prognosis of the patient. Case Presentation: We present a case of a 54-year-old male patient who presented with a rapidly growing ulcerative lesion in the right buccal mucosa for a duration of 4 months. The lesion was extending into the left alveolus, gingiva-buccal sulcus and retromolar trigone. The clinic-radiological evaluation showed bilateral swollen neck nodes with a subpleural small nodular mass lesion in the lateral segment of the right middle lobe. Histopathology taken from the lesion revealed moderately differentiated squamous cell carcinoma. Discussion: The role of cytopathology is often understood as a screening examination for detecting malignancies and histology in diagnosing tumours is the gold standard method. However, in the non-availability of histology, cytopathology has a crucial role in making the diagnosis of cell block preparation. Cell block preparation along with smears as tumour immunomarker studies provide a useful aid when the cytological picture is doubtful. Conclusion: The presentation of oral cavity tumour as bilateral pleural effusion is quite rare and the performance of cytopathological examination in diagnosing the tumour cannot be neglected.

   PP-034: Thyroid Tumor with Trabecular Pattern – A Diagnostic Dilemma Top

Savita Agarwal, Uttar Pradesh University of Medical Sciences, Saifai, Uttar Pradesh, India

A 41 one year old male presented with right thyroid lobe swelling since past one year. No other systemic complains were present. Hematologic and biochemical work up were within normal limits including Thyroid profile. FNAC from thyroid lesion showed cellular smears with presence of trabeculae, sheets and few micro-follicles. Nuclei were round to oval with overlapping and over-crowding. Fair number of nuclear grooves were observed. No intranuclear inclusion or psammoma bodies seen. Mitosis and necrosis were absent. Stroma showed extensive hyalinization. Possibility of Hyalinizing trabecular adenoma, and papillary thyroid carcinoma were suggested. Thyroid mass was excised and histopathological examination showed well encapsulated tumor showing prominent trabeculae with stromal hyalinization along with marked retraction artefact. At places follicular formations were also observed. No papillary formations seen. Nuclei were round to oval and uniform with conspicuous nuclear grooving. Nuclear chromatin was variably granular. Possibilities of Hyalinizing trabecular adenoma, papillary thyroid carcinoma, and poorly differentiated carcinoma were considered, IHC for TTF1, Thyroglobulin, CD56 and Pan CK were positive. Calcitonin, synaptophysin and chromogranin were negative. Ki67 index was <1%. Based on histomorphology and IHC diagnosis of follicular adenoma with trabecular pattern was considered.

   PP-035: Metastatic Sinonasal Melanoma – A Rare Case Report Top

Alok Kumar, AIIMS, Rishikesh, Uttarakhand, India

Background: Primary mucosal melanoma is rare neoplasm representing 0.7 % of melanomas and 4-8% of sinonasal malignancy as a whole. The annual incidence is reported to be 0.2-1 cases/ million. Mean age of diagnosis is 65-70 years and diagnosis is difficult and tend to be late due to lack of specific sign and predisposing factors. Case: A 58 year-old-male presented with a sinonasal mass along with cervical lymphadenopathy. There was bleeding from left nasal cavity for 8-9 months and left sided nasal obstruction for 4-5 months. On examination, blood clots were noted in bilateral nasal cavity along with left cervical lymphadenopathy. FNAC was done from the lymph node, which showed dispersed medium to large cells having moderate amount of cytoplasm with nucleus having vesicular chromatin, irregular nuclear membrane and prominent nucleoli. Melanin pigment was noted in cytoplasm and in the background. Subsequent biopsy from sinonasal mass showed features of IHC proven malignant melanoma. Discussion: Sinonasal melanoma is an aggressive neoplasm with high propensity to metastasise to the regional node and delayed diagnosis (median time to diagnosis is 5.6 months) due to lack of clinical suspicion. Due to anatomic complexity of the region these cases are difficult to manage. The mainstay of the treatment is surgical excision followed by radiotherapy and has poorer outcome compared to its cutaneous counterpart. Conclusion: Due to rarity of these lesions and atypical presentation, one should be mindful about these lesions. And immunohistochemical markers for melanoma should be applied in difficult lesions of sinonasal tract.

   PP-036: A Case of Solid Papillary Carcinoma (Invasive) of Breast in a Young Woman – A Very Rare Malignany with Cytological Diagnosis And Histopathological Confirmation Top

Vishal Seth, Aseema Das; Assam Medical College and Hospital, Dibrugarh, Assam, India

Introduction: Solid papillary carcinoma (invasive) is a rare breast malignancy that occurs primarily in postmenopausal women, mainly during the seventh decade of life or later, and are biologically indolent. They may present as a palpable breast mass, a mammographic abnormality, and/or a bloody nipple discharge. Case Report: A 21-year-old female presented with a painless rounded firm lump of size 4 X 3 cm in the left breast and a lump in the left axilla of size 1X1 cm. USG was done and it suggested a BIRADS V lesion. FNAC was done and it showed high cellularity comprising of atypical ductal epithelial cells arranged in complex branching epithelial sheets and finger-like fragments with strands of dense fibrovascular stroma. Individual cells were pleomorphic with mild to moderate nuclear atypia with moderate amount of cytoplasm and few rows of palisading columnar epithelial cells. Possibility of Papillary Carcinoma of the Breast was suggested and mastectomy was performed. The histopathological examination showed presence of expansile nodules with solid growth and inconspicuous fibrovascular core, composed of a monotonous population of round to spindle shaped epithelial cells with moderate nuclear atypia and eosinophilic granular cytoplasm with presence of occasional pools of mucin. The picture was consistent with Solid Papillary Carcinoma (invasive) of the breast and all the lymph nodes provided with the breast were also positive for malignancy. Conclusion: Solid papillary carcinoma has an excellent prognosis and hence an early identification and diagnosis by FNAC can greatly benefit in prompt excision and overall treatment of the patient and greatly reduce morbidity and mortality.

   PP-037: A Study Of Cytohistological Correlation of Equivocal or Atypical Proliferative Breast Lesions at a Tertiary Care Institution of North India Top

Meenu Gill, Raman Kapil, Sucheta Malik, Tripti Jain; Rohtak, Haryana, India

Background: Fine needle aspiration cytology is mostly the first diagnostic test used for the diagnosis of breast masses. But there is morphological overlap among the sequential lesions from the precancerous group to frank carcinoma known as grey zone. This grey zone in cytology is estimated to constitute 8.9% of cases. Methods: A total of 40 cases were included in the study, smears were prepared from the fine needle aspirates and stained with Leishman/Giemsa. Cytologically they were categorised as- Benign with atypia (C3)/ Suspicious of malignancy (C4). All the cases were subjected to histopathological evaluation and cytohistological correlation was done. Results: 75% (14 out of 18) patients who belonged to Category 3 had benign lesions whereas 90% (20 out of 22) patients of Category C4 had malignant diagnosis. This difference was statistically significant. Conclusions: Combination of the mammography and cytology along with the clinical findings (the triple test) allows for proper management for each patient, determining which patient should undergo surgery and which needs close follow up, hence avoiding an unnecessary surgery. And the patients in cytology category C4 must have the diagnosis confirmed by histological examination.

   PP-038: Cytodiagnosis of Invasive Papillary Breast Carcinoma, A Rare Subtype of Ductal Carcinoma of Breast Top

Nakib Ali Hazarika, Junu Devi; GMCH

Background: Invasive papillary breast carcinoma is a rare subtype of ductal carcinoma (IDC) with infiltrative papillary growth which accounts for (0.5-0.7) % of all invasive breast cancers. Generally presents during sixth to eighth decade of life in post menopausal women as a mass of (2-3 cm) in size. Invasive papillary carcinomas are ER positive and has favourable prognosis. It rarely metastasizes to axillary lymph node or distant site. Case Report: A 43 year old female presented with right sided breast lump since 1.5 years, which gradually increased in size, associated with intermittent pain. Multiple ulcerations appearing around the nipple areola complex since 1 year associated with bloody discharge. There was weight loss and decreased appetite since 3 months. Sonomammography of both breasts revealed BI-RADS Category 5: highly suggestive of malignancy in right breast and BI-RADS Category 1: negative in the left breast. On FNAC done in the cytology department, GMCH it was reported as infiltrating duct carcinoma with papillary features /invasive papillary breast carcinoma (Grade III) and further histopathological evaluation was advised. On further HPE it was confirmed to be a case of Invasive Papillary Carcinoma of the Right breast. Conclusion: Invasive papillary carcinoma must be distinguished clearly from other variants of malignant papillary neoplasm including papillary carcinoma in situ and encysted papillary carcinoma and benign papilloma with involvement by DCIS. Papillary carcinoma in general, have a slow growth rate and a better prognosis than other forms of breast carcinomas, with a 100% 10 year survival.

   PP-039: Cytomorphological Characterization of Papillary Carcinoma of Breast: A Case Report Top

Swagata Dowerah, Aseema Das; Assam Medical College, Dibrugarh, Assam, India

Background: Papillary lesions of breast show overlap in the cytomorphological criteria for benign and low-grade malignant lesions and a definite diagnosis may not always be possible. True invasive papillary carcinomas are rare neoplasms. We report the cytomorphological findings in a case of papillary carcinoma breast in a 20 year female diagnosed on cytology. Case Report: A 20 year old female presented with swelling in right breast for 6 months and bloody nipple discharge. On examination, an exophytic growth was seen 4 x 4 x 4 cms, near the nipple areola complex with ulceration. Stained smears from FNA of the swelling showed a cellular smear with atypical ductal cells in complex branching fragments with fibrovascular core along with some dispersed cells. The individual cells were pleomorphic with mild to moderate atypia, nuclear overcrowding, moderate amount of cytoplasm with some areas showing elongated columnar epithelial cells in a background of macrophages and RBCs. Scattered bizarre cells were also noted. Some hyaline globules were seen. The cytomorphological features suggested a diagnosis of invasive breast carcinoma (possibility of invasive papillary type). The same was confirmed on histopathology. Conclusion: Papillary carcinoma being a rare malignancy, its cytomorphological features are not well defined. However, in presence of cell dispersal, moderate atypia, cell balls and cellularity, we are of the opinion that a diagnosis of malignancy can be given. We reported this case to highlight the cytomorphological features in a histologically confirmed case of papillary carcinoma and also due to the young age of occurrence.

   PP-040: Ductal Carcinoma In Situ Arising Within Benign Phyllodes Tumor Top

Pallavi Mehra; Department of Pathology, Patna Medical College and Hospital, Patna, Bihar, India

Introduction: Phyllodes tumors are fibroepithelial breast tumors, they account for less than 1% of all breast neoplasms. The tumor clinically, radiologically, cytologically as well as histologically can mimic fibroadenoma which is a common tumor of fibroepithelial group. Malignant transformation of PT usually occurs in stromal component and is rare in epithelial component. Most of them are infiltrative ductal carcinoma and DCIS coexistence with PT is even more rarer. Case Report: A 42 year old lady presented with painless mass in upper outer quadrant for 1.5 years. On examination, the tumor was firm, well defined, non adherent to overlying skin. Few small axillary lymph nodes were palpable. Image guided FNAC from breast revealed atypical ductal cells suggestive of ductal carcinoma. Unfortunately trucut biopsy was not performed and based on the cytology report patient underwent radical mastectomy with axillary lymph node dissection. Histopathological examination revealed a tumor with biphasic morphology comprising of epithelial component and cellular spindle stroma. Stroma was moderately cellular with leaf like projections, monomorphic with minimal atypia and mitosis<2/10HPF without any heterologous stromal differentiation. On extensive examination, multiple foci of DCIS were noted and it was further confirmed on immunohistochemistry. Conclusion: Pathologist should be aware of this rare entity and carefully look for any atypia in epithelial component too, as done for stromal component to differentiate for borderline and malignant counterpart.

   PP-041: Malignant Phylloides Tumour – A Diagnostic Challenge on Cytology Top

P Ghosh1, G DasNayak1, P Mishra1, N Sahu1, S Mohanty1, R Panigrahi1, U Senapati1, S Sahu2; 1Department of Pathology, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India, 2Department of General Surgery, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India

Introduction: Phylloides tumor (PT) is a rare breast tumour constituting less than 1% of all breast neoplasms. Malignant phylloides tumour is an aggressive tumour constituting 25% of all phylloides tumors. Preoperative diagnosis of phylloides tumour is not always straightforward causing incomplete excision and recurrence. Cytological diagnosis of phylloides tumour is difficult and has important therapeutic implications. Case Report: A 53-year-old female presented with progressively increasing left breast lump since 6 months. Ultrasound showed a large ill-defined heteroechoic mass measuring 13.8×10.6 cm with internal cystic spaces suggesting a neoplastic etiology. FNA material was thick gelatinous. Cytosmears revealed features of benign stromal lesion, possibly phylloides tumour. Core biopsy revealed dysplastic polygonal to spindle cells in fibrocollagenous and myxoid stroma, suggesting a malignant mesenchymal neoplasm. Left mastectomy was performed. Grossly tumour measured 15.5x14.7x10.6 cm, cut section was solid with cystic and mucinous areas. Microscopic examination revealed increased stromal cellularity with moderate atypia. Tumor cells had moderate cytoplasm, vesicular to coarse clumped chromatin, some with prominent nucleoli. Mitotic count was 14/10 HPF. Tumour cells were positive for CD-34. Ki- 67 index was 50%. A final diagnosis of malignant phylloides tumor was made. Conclusion: Stromal tumours must be considered in differential diagnosis of breast lumps. Accurate diagnosis and grading of phylloides tumour on cytology is often challenging. Biopsy and immunohistochemistry aid in arriving at the correct diagnosis.

   PP-042: To Highlight Diagnostic Importance of Cytomorphological Assessment of Nipple Discharge Top

Neha Goyal, Snigdha Goel, Mukul Singh, Charanjeet Ahluwalia, Neha Madan, Sunil Ranga, Ankita Ratnakar; Vardhman Mahavir Medical College and Safdurjung Hospital, New Delhi, India

Background: Nipple discharge is third most common complaint of patients in case of breast disease. Causes of Nipple discharge can be physiological or pathological like abscess, birth control pills, infection, mastitis, intra ductal papilloma etc. Case Study: We present a case series of 15 patients who presented in year 2020 to 2022. All patients had unilateral discharge but with no lump in bilateral breast. Imprint cytology of nipple discharge of these patients was done. It showed 3 patients had papillaroid clusters of ductal epithelial cells. 2 out of these 3 cases showed intraductal papillomas on USG. 2 cases were of breast abscess, in which one case showed retroareolar prominent duct on USG suggestive of papilloma.1 case each was of Galactocele, tubercular mastitis and Microfilarial infestation. Infectious cases ie Microfilaria and tubercular mastitis presented with retroareolar swelling but no definitive lump. 7 cases yielded only macrophages in proteinaceous background. 2 cases out of these 7 cases presented with bloody discharge and rest 5 showed serous discharge. 2 out of 3 cases with papillaroid lesions presented with bloody discharge. Cases with infectious etiology presented with bloody discharge and both cases of abscess presented with purulent discharge. Conclusion: Nipple discharge cytological examination helps in identifying high risk cases. It is easy to perform and reliable in conjunction with surgical and radiological testing. In our study 53% cases showed significant pathology in the breast with 100% diagnostic material on cytology.

   PP-043: Cytomorphologic Features of Pleuropulmonary Blastoma: A Case Series from a Tertiary Care Institute Top

Sanjoli Chugh, Parikshaa Gupta, Nalini Gupta, Kirti Gupta, K S Sodhi, Reetu Kundu, Pranab Dey, Radhika Srinivasan, Amita Trehan; Department of Pediatrics, PGIMER, Chandigarh, India

Introduction: Pleuropulmonary blastoma (PPB) is a rare, aggressive, primary intrathoracic malignancy, seen in infancy and early childhood. It can arise from the lung parenchyma, pleura or mediastinum. In the infants, PPBs are readily mistaken for congenital cystic lesions of the lungs, which are prognostically and therapeutically different. Cytologic features have been rarely described. Establishing a cytodiagnosis is challenging owing to its rarity, lack of awareness, and multiple morphologic mimics. Materials and Methods: This was a retrospective study conducted over 7 years. The histopathology database was searched for all PPB cases with corresponding cytologic samples. All the cytomorphologic features were studied to identify characteristic features that can help distinguish it from its mimics. Results: There were a total of 6 cases of PPB reported on histopathology. Five of these had corresponding cytologic aspirates; 3 presenting as intrathoracic and 2 as pleural-based masses. Two (40%) cases could be diagnosed on cytology and immunocytochemistry. FNA smears were variably cellular with discretely scattered, loose clusters and perivascular arrangement of round-oval tumor cells with background eosinophilic stromal material. The tumor cells were mildly pleomorphic (n=3) with round nuclei, fine chromatin, inconspicuous nucleoli and scanty cytoplasm; however, 2 cases showed marked anaplasia. One case showed rhabdoid differentiation. On immunocytochemistry (2/5), these were positive for vimentin, CD117, and were negative for WT1, chromogranin, SALL4, cytokeratin, CD45, and CD99. FISH done in one case, did not show N-Myc amplification. Conclusions: Knowledge of the characteristic cytomorphological and immunocytochemical features of this entity is important to establish a prompt and accurate cytodiagnosis.

   PP-044: Microfilaria in Young Pregnant Female Presenting with Breast Mass and Ascites Top

Sunita Singh, Meenu Gill, Niti Dalal, Veena Gupta, Promil Jain, Sumiti Gupta; Department of Pathology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India

Introduction: Filariasis is a major health issue of tropical and subtropical regions and is endemic in India. It is rarely seen in cytology smears, exfoliative scrapings and effusions. We present a case of a 32 year old female with microfilaria found on cytological examination in the breast and ascitic fluid. Case Report: A 32 year old, 32 weeks pregnant female (G2P1L1) presented with mass in left breast. Ultrasonography report showed a hypoechoic lesion measuring 4.0 X 4.0 cm with BIRADS 4 in the left breast. USG guided fine needle aspiration cytology smears showed large number of degenerative and inflammatory cells, groups of epithelial cells revealing degenerative changes and lactational changes alongwith numerous microfilaria. Post delivery patient developed dyspnea, bilateral pedal edema and ascites. Abdominal MRI scan showed ascites and multiple soft tissue lesions in peritoneum. Haemorrhagic fluid was aspirated which showed inflammatory cells, macrophages, mesothelial cells and microfilaria on cytological examination. Conclusion: Present case highlights the importance of cytological examination in diagnosing the microfilarial infection in patients with suspected malignancy in the endemic areas.

   PP-045: Comparative Analysis of Fibreoptic Bronchoscope Aided Cytohistological Techniques in Diagnosis of Benign and Malignant Lesions of Lung Top

Shilpa Garg, Sanjay Verma, Rajnish Kalra, Sonia Hasija, Puja; 1PGIMS, Rohtak, Haryana, India, 2SHKM GMC Nalhar, Nuh, Haryana, India

Background: Morbidity and mortality from chronic lung diseases are increasing worldwide. A combination of various cytological and histopathological techniques are required for the high diagnostic accuracy. Aim: To evaluate and compare the diagnostic accuracy of fiberoptic bronchoscope aided cytohistological techniques such as BAL (bronchoalveolar lavage), TBNA (Transbronchoscopic needle aspiration) and FB (forceps biopsy) in diseases of lung. Methods: A prospective study was conducted on 100 patients with symptoms and signs of various respiratory diseases who underwent fibreoptic bronchoscopy. The diagnostic accuracy of various samples alone and in combination were analysed. Results: Sensitivity of BAL was 24%, TBNA 64% and FB 66%. Addition of BAL to FB increased the sensitivity to 69%. Addition of BAL to TBNA increased the sensitivity to 70%. Sensitivity of cytological methods (FB and TBNA) was 90%. Addition of both BAL and TBNA to FB increased the overall senstivity to 93%. Forceps biopsy was the most specific amongst the three techniques with specificity of 94% followed by TBNA (59.4%) and BAL (50%).

   PP-046: EGFR PCR on Cytology Smears: Experience From a Tertiary Care Centre Top

Ashok Singh, Pranoy Paul, Shalinee Rao, Nilotpal Chowdhury, Swati Rajput; AIIMS, Rishikesh, Uttarakhand, India

Lung cancer is the leading cause of cancer-related death worldwide. Identifying driver mutations is important for treatment. PCR or sequencing is the method of choice for EGFR. In this study, we compared the suitability of archived FNAC slides of non-small cell lung carcinomas (NSCLC) for performing EGFR mutation analysis. Ten cases were included for EGFR detection by PCR and 3 cases showed the presence of mutations. Study highlights that archival cytology smears can be a viable alternative for PCR studies.

   PP-047: Large Cystic Space Occupying Lesion in the Lung: A Diagnostic Enigma for Pathologists Top

Nilanjana Mondal, Anup Kumar Roy

Cystic lung diseases represent a heterogeneous group of disorders occupying a wide spectrum. For this reason, a detailed evaluation combining clinical radiological, cytological and histological findings along with immunohistochemical analysis is necessary to arrive at a definite diagnosis. Here we present a 41 years female with cough for 7 months, right sided chest pain for 1 month and weight loss. There were no history of tuberculosis and animal contact. On examination no pallor, clubbing, cyanosis were noted. CT scan of thorax revealed a large thin walled cystic swelling occupying >3/4th of right hemithorax. The report was suggestive of pulmonary hydatid cyst. FNA revealed highly cellular smears having monotonous sheets of plump and slender ovoid and spindle cells in a background of hemorrhage. No brisk mitosis were noted. However, no scolex and protoscolex were found. The features were suggestive of spindle cell neoplasm. CT-guided biopsy was suggestive of high grade sarcoma. The differentials were-

  1. Solitary fibrous tumour,
  2. Carcinosarcoma,
  3. Synovial sarcoma.

Here we present an enigmatic case which was confirmed using IHC panel in this clinical background which was initially suggested as pulmonary hydatid cyst on radiology.

   PP-048: Malignant Thymoma – A Rare Diagnosis by Fine Needle Aspiration Cytology Top

Vibhuti Goyal, Anjana Arya, Mithila Bisht, Nitesh; Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India

Introduction: Thymoma is a rare tumor derived from thymus epithelial cells. It is the most common anterior mediastinal tumor. Thymic cancers are extremely rare with incidence of 0.03-0.06 per 100,00 population. Thymic epithelial neoplasms are usually seen in the fourth and fifth decades of life. A cytological diagnosis of thymoma is extremely challenging because the tumor is uncommon and aspirates are infrequently encountered. Case Report: A case of 25 years old male patient presented with chest pain, fever and shortness of breath in our institute. He was diagnosed as case of abdominal tuberculosis 3 years back and was put on ATT. CECT Chest showed anterior mediastinal mass extending to middle mediastinum encasing the major vessels and right main bronchus with severe compression of superior vena cava. Ultrasound guided FNAC was done from mediastinal mass which revealed loosely cohesive clusters of polygonal epithelial cells intermingled with lymphoid cells. Based on FNAC findings, malignant thymoma diagnosis was made. Conclusion: The present case was unusual due its rarity. We must consider the possibility of thymic neoplasm of thymic neoplasm even in a young patient presented with mediastinal mass. FNAC along with clinical and radiological findings renders a definitive diagnosis of thymoma.

   PP-049: Metastatic Giant Cell Tumor Presenting as a Huge Mediastinal Mass After 20 Years – A Rare Case Report Top

Raisa Karim, Kaushik Saha, Anadi Roy Chowdhury; MSDMCH

Introduction: Giant Cell Tumors (GCTs) of the bone are not benign but potentially malignant osteolytic tumor commonly occurring in the 3rd to 4th decades with distal femur being the most common site. Metastasis is very uncommon and seen only in 10% cases. The Case: 38 years old male presented with a huge well defined mediastinal mass involving the lower lobe of right lung. Differential diagnosis were primary mediastinal tumor or primary lung carcinoma. CT guided FNAC was done. Cytological features showed hypercellular aspirate with multiple osteoclastic type giant cells and stromal cells having similar nuclear feature. Primary Giant Cell Tumor of mediastinum was suspected and urgent CT guided tru-cut biopsy was advised. Sections from the neoplastic growth showed evenly distributed multinucleated osteoclastic type giant cells admixed with mononuclear stromal cells having round and or oval nuclei with smooth chromatin and small nucleoli. The stromal cells are focally elongated. Foci of haemorrhage, stromal edema and scanty mitotic figures were present. On immunohistochemistry, both the giant cells and the stromal cells show cytoplasmic positivity for CD68 and vimentin and negative for CD34. Taken together, all these evidences confirmed the diagnosis of Giant Cell Tumor. [D/D:Metastatic Giant Cell Tumor /1 Mediastinal Giant Cell Tumor]. Conclusion: Primary Giant Cell Tumor of mediastinum is an extremely rare condition. Metastasis though uncommon is usually seen with recurrences. Previous history revealed history of bone tumor at the lower end of femur twenty years back. For this history we diagnosed the case as metastatic GCT.

   PP-050: Nut Carcinoma in Exfoliative Cytology: Report of Two Cases Top

Urvashi Yadav, Hena Khandakar, Anant Mohan, Prabhat Singh Malik, Aruna Nambirajan, Deepali Jain; 1Department of Pathology, Medical Oncology (IRCH), AIIMS, New Delhi, India, 2Department of Pulmonary Medicine, Medical Oncology (IRCH), AIIMS, New Delhi, India

Introduction: NUT (nuclear protein in testis) carcinoma is an aggressive carcinoma that arises in the midline structures of the upper aerodigestive tract and mediastinum. It is an aggressive neoplasm defined by rearrangements in the NUTM1 gene and often presenting at an advanced stage with frequent metastases. Scant literature on the cytopathologic appearance of NCs shows that the morphology is relatively nonspecific and mimics other primitive small round cell tumors or basaloid neoplasms. Case Summary: Case 1: A 58-year old male chronic smoker presenting with left upper lobe lung mass associated with pleural effusion. Pleural fluid cytology showed mesothelial cells in clusters, necrotic debris, along with cohesive clusters of cells with scant cytoplasm and conspicuous nucleoli. Pleural biopsy showed a basaloid tumor with large areas of necrosis positive for NUT protein clinching the diagnosis. Case 2: A 49-year old male smoker with silica exposure presented with chest discomfort, loss of weight, streaky hemoptysis along with right lower lobe bronchial infiltration. Bronchial brush cytology showed columnar cells, necrosis, along with two populations of tumor cells: some basaloid with scant cytoplasm and conspicuous nucleoli and some polygonal with more abundant clear cytoplasm raising suspicion for NUT carcinoma. Diagnosis of NUT carcinoma was confirmed on the biopsy by NUT immunohistochemistry. Conclusion: Cohesive clusters of basaloid cells with conspicuous uniform nucleoli, necrosis, and rare clusters of larger cells with more abundant cytoplasm were the features observed in NUT carcinoma on cytology. Confirmation of diagnosis rests on the demonstration of NUT rearrangement usually by immunohistochemistry.

   PP-051: Occult Filariasis in Squamous Cell Carcinoma Of Lung, A Very Rare Finding Top

Gitimadhuri Dutta, N Sansina, Radhamohan Gharei; Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India

Background: Filariasis is a parasitic disease endemic to regions of Indian subcontinent, Africa, South East Asia and South America. Though, often limited to the lymphatic system, occult filariasis (microfilariae in organs) may present. One such organ is the lung and its involvement usually presents as Tropical Pulmonary Eosinophilia with incidence of <1% of all filariasis. Occult filariasis of lungs is a rare disease and its coexistence with another lung pathology has rarely been reported. Here we present a case of occult filariasis in a patient with squamous cell carcinoma of lung due to its rarity and atypical clinical presentation. Case Report: 80 years old male, known smoker, presented with chest pain, cough and breathlessness. His blood investigations revealed leukocytosis (TLC = 21.47 x 103/μl) with eosinophilia (AEC = 1.40 x 103/μl). CECT thorax showed a heterogeneously enhancing mass of size 10.8x8.2x10.6 cm in the lower lobe of the left lung with mediastinal lymphadenopathy and left side pleural effusion. He underwent USG guided FNAC which revealed scattered microfilaria along with plenty of cyst macrophages, polymorphs and lymphocytes. Later, Bronchoscopy guided biopsy showed features of well differentiated SCC, currently under treatment with Gefitinib. Discussion: Filariasis is a neglected parasitic disease. Filariasis in lung SCC patient is a very rare presentation and so far, there is no information available in literature. This could raise significant confusion regarding their association and further management of the patient.

   PP-052: Cytology as a Tool for Diagnosis of Echinococcosis Top

Aanchal Mahajan, Meenakshi Rao, Aasma Nalwa, Savita Singla, Taruna Yadav; All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Introduction: Hydatid cyst is a zoonosis caused by infestation with larval tapeworms Echinococcus granulosus. It mainly affects the liver and is extensively distributed worldwide, but is endemic in sheep-raising regions. The definitive diagnosis of echinococcosis requires a combination of imaging, serologic, and immunologic studies. Herein, we present a case of hydatid cyst diagnosed cytologically. Case Presentation: A 9-year-old male presented with history of non-radiating abdominal pain for 1 year, associated with mild on and off fever. CECT suggested multiple well defined hypodense cystic lesions in bilateral lobes of liver, largest measuring 2.8 x 2.8 x 2.4 cm (AP x TR x CC) in segment VII, the diagnosis of which was confirmed on wet mount preparation and cytological smears, made from reddish, turbid cystic fluid aspirated from liver. After processing of cyst fluid, wet mount preparation and smears were prepared and microscopic examination revealed hooklets of echinococcus with lymphomononuclear cells in a dirty proteinaceous background. Following cytological diagnosis, patient underwent exploratory laparotomy with cystectomy and marsupialization and the cysts were removed. Histopathology further confirmed the cytological diagnosis. Conclusion: The diagnosis of hydatid cyst should be kept in mind when there is cystic lesion and cytology findings reveal amorphous necrotic debris. Cytology is useful for confirmation of hydatid cyst and may help in timely management of the disease.

   PP-053: Deep Seated Histoplasmosis in an Immunocompetent Patient Top

Jagriti Singh Fartiyal, Aasma Nalwa, Meenakshi Rao, Vikrant Verma, Abhishek Purohit, Poonam Abhay Elhence, Taruna Yadav; All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Introduction: Histoplasmosis is caused by Histoplasma capsulatum, an intracellular uninucleate dimorphic fungus, seen within the cytoplasm of macrophages. It presents as a disseminated form mostly in immunocompromised patients. Herein, we describe a case of disseminated histoplasmosis in an immunocompetent patient diagnosed on Fine Needle Aspiration Cytology (FNAC). Case Details: 49 year-male, presented with multiple skin coloured umblicated papules all over body for 3 months with a well- defined round lesion with peripheral calcification in hepatorenal pouch, involving right adrenal with hypodense lesion along segment VII of liver radiologically. USG guided FNAC from hepatorenal space lesion showed many intracellular and extracellular narrow- based budding forms, morphologically resembling Histoplasma capsulatum, that were confirmed on Gomori Methenamine silver stain. Further skin and bone marrow biopsy showed similar fungal profiles. Discussion: H. capsulatum is found predominantly in soil enriched with bird and bat excreta and spreads via inhalation. Infection is mostly self- limited to lungs in cases with no pre- existing immunodeficiency. The disseminated form occurs in immunocompromised states like HIV/AIDS, haematological malignancy, solid organ transplants etc. The common cytomorphological differentials include, Cryptococcus neoformans, Blastomyces dermatitidis and Leishmania donovani and are differentiated on basis of size, localisation and cytomorphology. Conclusion: Disseminated histoplasmosis commonly affects immunocompromised patients and is extremely uncommon in immunocompetent individuals and needs to be timely diagnosed as it is fatal. FNAC can be a promising modality for rapid confirmatory diagnosis of histoplasmosis and thereby early treatment initiation.

   PP-054: Desmoplastic Round Cell Tumour – A Rare Case Presentation Top

Shubham Solanki, Mithila Bisht, Vibhuti Goyal, Nitesh Mohan; Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India

Introduction: Desmoplastic small round cell tumour is a rare but highly fatal malignancy of mesenchymal origin whose oncogenic effect is presumed to originate from the unique chromosomal translocation t (11;22) (p13:q12) involving the EWSR1 gene. Most common site is intra abdominal but the tumour can involve the pelvis, retroperitoneum, scrotum and pleura. It is composed of undifferentiated small blue cells arranged in sharply demarcated in background of vascular desmoplastic stroma. Peak incidence in third decade of life. The age adjusted incidence rate was 0.3 cases /million, with a peak incidence of 0.74 cases /million in persons 20-24 years of age. Case Report: We report a case of 26 year old female presented with swelling in right iliac fossa 10 x 8 cm since 4 months. The swelling increased in size and was associated with lower abdominal pain, change in bowel habit, weight loss, obstructive urinary symptoms. Cut surface was firm and greyish white, with foci of necrosis and haemorrhage. Smear show cells arranged in rosette like pattern with small amount of fibrillary material. Cells are hyperchromatic with small amount of cytoplasm. Few smears also show polymorphs and degenerated cells in necrotic background. Microscopy revealed sheets of small round cells having small to intermediate sized rounded nucleus, fine chromatin, regular nuclear boundaries, hyperchromatic nuclei, inconspicuous nucleoli, scanty cytoplasm, tumour. Conclusion: Desmoplastic round cell tumour is a rare and is highly malignant. It should be considered in case of abdominal tumour/mass/cyst.

   PP-055: Diagnostic Utility of Fine Needle Aspiration Cytology in Case of Small Round Cell Tumor Presenting with Metastasis Top

Payal Chawhan, Juhi Shahab, Mukul Singh, Poonam Khambra, Sunil Ranga; Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Background: Neuroblastoma is the 4th most common tumor of childhood. The most frequent site for these tumours are adrenal glands and retroperitoneal sympathetic ganglia. One third of the cases present with metastasis. In our case fine needle aspiration cytology (FNAC) turned out to be simple and efficient procedure in picking up the diagnosis of small round cell tumor (SRCT). Case Summary: A 4-year-old male child presented with complaints of abdominal mass, fever and scalp swelling since 3 months. On CECT Abdomen and pelvis, large necrotic mass in the gastrosplenic region was seen. On NCCT Brain, multiple lytic lesions on bilateral frontal and parietal bones of the skull was seen. USG guided aspiration of abdominal lump revealed small round blue cell tumor. FNAC of scalp swelling was suggestive of small round blue cell tumor likely Neuroblastoma. The histopathological examination of pelvic mass showed strong possibility of Neuroblastoma. Conclusion: SRCT includes a broad spectrum and needs confirmation through histopathology and Immunohistochemistry for definite categorization. As FNAC is a minimally invasive and rapid technique when used along with ancillary studies its diagnostic utility can be increased to many folds.

   PP-056: Endoscopic Ultrasound Guided FNAC of Pancreatic Lesions – Two Year Experience in a Tertiary Care Hospital, Mangalore Top

Y Sunil Kumar, K S Hegde Medical Academy, Mangalore, Karnataka, India

Endoscopic ultrasound guided fine needle aspiration cytology (EUS-FNAC) is highly accurate investigation for pancreatic lesions and helps in early diagnosis and management of patients. Fifty-two (52) cases were included in our study at Justice K S Hegde Charitable Hospital, Mangalore from January 2020 to December 2021. The male to female ratio was 2:1 and mean age was 52 years. The cytological diagnosis was categorized according to Papanicolaou system of reporting pancreatic cytology which included category II (benign)- 25%, category III (atypical)- 5.77%, category IV (benign neoplasia)- 7.69%, category V (suspicious of malignancy)-1.92% and category VI (malignant)- 59.62% of cases. No cases were seen in category I (unsatisfactory). On histopathological examination, the neoplastic lesions accounted for 69.23% while non-neoplastic lesions accounted for 26.92%. Adenocarcinoma was the most common neoplastic lesion, accounting for 59.62% cases followed by neuroendocrine tumour (3.85%) and solid pseudopapillary neoplasm, spindle cell neoplasm and chronic pancreatitis with low grade dysplasia (1.92% each). Chronic pancreatitis was the most common non- neoplastic lesion (17.31%), followed by acute pancreatitis and benign non neoplastic lesion (3.85% each) and pancreatic cyst (1.92%). The sensitivity was 100%, specificity 92.86%, PPV 97.3%, NPV 100% and diagnostic accuracy 98%. EUS-FNAC accompanied by ROSE will increase the sensitivity and specificity of cytological diagnosis. However; all cases should be accompanied with cell block /histopathological examination for further ancillary studies like IHC/molecular studies whenever required.

   PP-057: Hydatid Cyst of Ovary – A Rare Case Report Top

Soumik Ganguly, Deep Banerjee, Pranati Bera, Biswajit Halder, Bidyut Krishna Goswami

Introduction: Hydatid disease, caused by Echinococcus granulosus commonly occurs in liver followed by lungs and spleen rarely. Also It can occurs rarely in other organs, however ovarian hydatid disease a very rare. Clinical Presentation: A 30 years old female presented with fever, abdominal swelling, pain and discomfort in right lower abdomen. Investigation: CBC Unremarkable except mild anemia (Hb-9.5 gm/dl) ESR: 35 mmin 1st hr. Blood Biochemistry: Unremarkable. Radiological- Ultrasonography (USG) lower abdomen showed cystic mass in right ovary, size measuring (8 x 6 x 5 cm) and loculated–Can not rule out ovarian neoplasm. USG guided FNAC (Aspirate: Clear transparent fluid) was done. Routine dry and wet fixed smears were prepared. After ovarian resection histopathological examination was done. Post operative period was uneventful. Microscopic examination showed fragments of laminated eosinophilic membranous structure, scolex and detached hooklets in Leishman and H/E stained smears. Provisional diagnosis of ovarian hydatid cyst was made. Subsequently confirmed by histopathological examination. Conclusion: This case exemplifies the unusual sites and presentation of hydatid disease often misdiagnosed as neoplasm. Early diagnosis with simple FNAC may prove helpful in diagnostic dilemma of adnexal masses.

   PP-058: To Evaluate The Role of Fine Needle Aspiration Cytology (FNAC) as a First Line Of Investigation in Space Occupying Lesions of Liver Top

Rashan Kullar, J K Bhatia, Vikram Singh, Shamresh Kumar, Surender Singh; Army Hospital Research and Referral, New Delhi, India

Background: FNAC is less invasive and rapid method in evaluation of liver space occupying lesion (SOL) as compared to biopsy. Early diagnosis decreases the length of stay in hospital and minimizes further ancillary investigations. As diagnostic accuracy of FNAC is high enough, early management can be initiated, and prognosis can be predicted with certainty. In correlation with clinical, radiological and accurate sampling, well prepared FNAC smear yields the best results. Materials and Methods: A retrospective study, record of total of 107 cases where image guided Fine needle aspirations of liver SOL done during the period of Jan 2020 to Aug 2022, were analyzed. Epidemiological, radiological and FNAC findings and final Histological diagnosis were recorded. Concordance with FNAC and final HPE diagnosis was analyzed. Results and Discussion: Age ranged from 03 to 83 yrs. 74 out of 107 FNAC were conclusive. 07 out of 74 were benign lesions, 11 cases were reported as negative for malignancy, 2 suspicious for malignancy, 54 were malignant. Out of malignant cases majority were metastatic deposits and 05 primary liver malignancies. Metastatic lesions (n=50) including adenocarcinoma, squamous cell carcinoma, poorly differentiated carcinoma, Burkitt's lymphoma and small cell carcinoma lung. Final Histopathological examination (HPE) was available in 60 cases and concordance was 90%. Conclusions: FNAC is less invasive and rapid method of diagnosing a lesion as compared to biopsy.

   PP-059: A Rare Case of Disseminated Pheohyphomycosis in a Known Case Of Leprosy: Role of Fine Needle Aspiration Cytology Top

B K Chandana, Shakti Kumar Yadav, E Jayashankar, Jai Kumar Chaurasia, Hemlata Panwar, Dinesh Asati

Background: Pheohyphomycosis is a rare fungal infection caused by brown-pigmented (phaeoid) or dematiaceous fungi. It usually presents as a localized subcutaneous cyst or abscess. Rarely verrucous plaques and pustules can occur in phaeohyphomycosis. The other major clinical forms of phaeohyphomycosis are infection of the paranasal sinuses and central nervous system. Immunosuppression is known to increase the risk of pheohyphomycosis infection. Case Report: We report a case of a 66-year-old male patient diagnosed with leprosy 20 years ago taking on and off treatment, presented with multiple skin coloured shiny infiltrated umbilicated nodules over and trophic ulcers on left forehand and foot. FNAC showed numerous pigmented and non-pigmented fungal elements in form of irregularly swollen and toruloid hyphae as well as yeast and chain form against a necrotic background. Gomori methenamine silver stain and Masson Fontana stain show fungal elements of above morphology and a diagnosis of Pheohypomycosis was suggested on cytology. FNAC from bilateral inguinal lymph nodes showed granulomas and Fite stain was also positive for Leprae bacilli. Conclusion: In patients with long standing leprosy, phaeohyphomycosis can occur as opportunistic infection and can present as skin nodules. This case highlights the importance of cytology and special stains in diagnosis of Pheohyphomycosis.

   PP-060: A Rare Case of Recurrent Monophasic Synovial Sarcoma With Nerve Involvement Top

Mala Sagar, Madhu Kumar, Sumaira Qayoom, Anurag Singh; King Georges Medical University, Lucknow, Uttar Pradesh, India

Introduction: Synovial sarcomas (SS) are rare tumors, commonly affect adolescents and young adults. They are generally found in the paraarticular areas of the tendon sheaths and joints, more commonly around knee joint. Intraneural SS are extremely rare and often difficult to diagnose due to close resemblance with primary neural tumors clinically and histologically. Case Presentation: A 10 year boy presented to the department of surgical oncology with recurrent swelling of right upper arm close to axilla with chief complaints of weakness, pain and difficulty in hand movement. On examination wrist drop and muscle wasting was noted in right arm. MRI showed well-defined lobulated altered signal intensity lesion in medial compartment of intermuscular plane along axillary neurovascular bundle. Fine needle aspiration cytology showed features of spindle cell sarcoma. Core needle biopsy revealed interlacing fascicles of spindle cells with areas of hemangiopericytomatous pattern. There were no myxoid area, hyalinized, necrosis or inflammation. The spindle cells were positive for vimentin, BCL2, EMA, CD99 and negative for S-100 protein, SMA, CD34, desmin. On the basis of histomorphology and immunohistochemistry definitive diagnosis of monophasic synovial sarcoma was given. Conclusion: Synovial sarcoma should be considered in differential diagnosis of spindle cell sarcoma in a young patient with neuronal symptoms. Although molecular diagnosis with detection of SYT- SSX fusion gene transcript is now the gold standard for diagnosis of SS; on unavailability of cytogenetic facilities at many centres, a pannel of immunohistochemical markers can be used to make a correct diagnosis.

   PP-061: Cutaneous Metastasis as a First Presentation of Lung Carcinoma – A Rare Case Report Top

Mayank Agrawal, Anjana Arya, G D Katiyar, Vibhuti Goyal, Nitesh Mohan; Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India

Introduction: Lung cancer is the second most common cancer and leading cause of death worldwide. The most frequent metastasis from lung cancer is to Hilar lymph nodes, brain, adrenal glands and bone, but rarely to skin. The incidence of cutaneous metastasis is 0.7-9% of all patients with cancer. Case Report: We report a case of 45-year-old female patient who presented with a painless swelling over right upper lateral chest wall since 7 months. Fine needle aspiration cytology reveals presence of atypical cells in clusters, acini and dispersed singly and diagnosed as metastatic carcinoma. On further examination, CT-scan was done which reveals an ill-defined heterogeneously enhancing mass lesion with central areas of necrosis in the hilar region with abrupt cutoff of the left upper bronchus. Conclusion: We report a case of cutaneous metastasis in lung carcinoma in a 45-year-old female based on cytological and CT-scan findings. The case is presented due to its rarity of site of metastasis.

   PP-062: Cutaneous Metastasis of Nasopharyngeal Carcinoma; A Rare Presentation Top

Mithilesh, King George's Medical University, Lucknow, Uttar Pradesh, India

Introduction: Nasopharyngeal carcinoma is relatively common. Cutaneous metastases are exceptional, as they are observed in only 0.7-9% of all cancers and metastasis from head and neck cancers are very rare, estimated to account for 9.1% of all cutaneous metastases. Nasopharyngeal carcinoma (NPC) has the highest metastatic rate among head and neck cancers, with its underlying mechanism not yet fully unveiled. Metastasis is the main reason for treatment failure in NPC patients. Among the organs that are frequently colonized by cancer cells, the bone is the most common metastatic NPC site, followed by the lung, the liver, distant lymph nodes. Case Report: A 35 years old male previously diagnosed as nasopharyngeal carcinoma 2 years back, for which he received 28 cycles of radiotherapy and 6 cycles of chemotherapy on regular follow up has now presented with abdominal midline nodular swelling for past 2 months and right post auricular lymphadenopathy in the last follow up. FNA smears from the abdominal nodule showed malignant epithelial cells disposed in sheets and clusters with indistinct cell borders and few singly scattered cells against background of tumor diathesis. Individual atypical cells had high nucleocytoplasmic ratio, moderately pleomorphic, round to oval nuclei, vesicular chromatin, conspicuous nucleoli and scant to moderate amount of cytoplasm. Results: Case was diagnosed as cutaneous metastasis of Nasopharyngeal carcinoma. Conclusion: Nasopharyngeal carcinoma with cutaneous metastases is a rapidly fatal disease. Cutaneous metastases are correlated with a more advanced primary tumour. It is an extensively disseminated disease that needs to be timely diagnosed to improve treatment and prognosis.

   PP-063: Cytodiagnosis by Tzanck Smear: 5 Year Experience at Tertiary Care Center Top

Rashim Sharma, Poonam Abhay Elhence, Divya Agarwal, Meenakshi Rao, Aasma Nalwa, Sudeep Khera, Deepak Vedant, Vikarn Vishwajeet, T Balamurugan, Anupama Bains, Suman Patra, Saurabh Singh; All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Background: Tzanck smear is rapid, simple, cost-effective screening test. Described by Arnold Tzanck in 1947 in blistering disorders. With advent of histology, virology, and techniques like PCR and electron microscopy, the use of tzanck smears is reducing. Aims: This study aims to evaluate tzanck smears. Materials and Methods: Tzanck smears from 335 patients were assessed from 2017-2021 (5-year period) in the Department of Pathology and Lab Medicine. The findings were grouped as positive/ negative acantholytic cells (PA/NA), positive/ negative viral cytopathic effects (PV/ NV), suspicious for herpes (SUH), fungal profiles (FP), inflammatory (I), negative for atypical cells (NAC) and no opinion possible (NOP). Results: Of 335 patients, 185 were male and 150 female with age range from 6 months to 71 years. As per the groups made PA were 64 cases, NA were 169 cases, PV were 25, NV were 32 and SUH were 7. 6 showed fungal profiles, 2 were inflammatory, 1 was NAC and 29 NOP. 206 cases had clinical history and site provided of which, 37 were PA, 92 were NA, 18 were PV, 29 were NV, 2 were SUH, 23 were NOP. 129 cases had no history or site provided of which 27 were PA, 77 were NA, 7 were PV, 3 were NV, 5 were SUH and 6 NOP. Conclusion: Tzanck smear should be promoted for its ease, minimal discomfort to patients, faster diagnosis and rapid treatment. However, expertise is required in doing the procedure and interpreting cytology.

   PP-064: Cytodiagnosis of Asymptomatic Multiple Myeloma Presenting as Solitary Plasmacytoma Top

Shrutilekha Sharma, Junu Devi; Gauhati Medical College and Hospital, Guwahati, Assam, India

Background: Multiple myeloma presenting as solitary plasmacytoma is rare. About 3-5% of patients with plasma cell disorder present with solitary plasmacytoma which affects the axial skeleton usually. Plasma cell neoplasms may manifest as diffuse myeloma with systemic involvement (multiple myeloma), monoclonal gammopathy of undetermined significance (MGUS), or as variants of plasma cell myeloma. Case Report: A 63 years old male presented with swelling over left upper arm for 6 to 8 months, painless and gradually increasing in size with no other complaint. X-ray of the left shoulder joint revealed an osteolytic lesion in the proximal shaft of humerus and USG of the same was suggestive of hemarthrosis of left shoulder joint with bony destruction. On fine needle aspiration cytology done in the cytology department, GMCH it was reported as solitary plasmacytoma and further evaluation was advised. Further haematological, biochemical, radiological, bone marrow analysis and immunohistochemistry confirmed it to be a case of multiple myeloma. Conclusion: The present case points out the unusual presentation of asymptomatic multiple myeloma with plasmacytoma and highlights the utility of fine needle aspiration cytology in such cases. In absence of typical clinical presentation, suspicion of the diagnosis might have not been made clinic-radiologically. Thus, FNAC aids in early diagnosis, hastening meticulous diagnostic workup and appropriate management of these patients.

   PP-065: Cytodiagnosis of Eumycotic Mycetoma Top

Sangeeta Pradhan, AIIMS, Jodhpur, Rajasthan, India

Background: Mycetoma is a chronic and progressive granulomatous infection caused by true fungi eumycetoma or aerobic Actinomyces. It effects dermal and subcutaneous tissue that may extend to muscle or even bone. Eumycetoma is endemic in tropical countries, in particular in Sudan and the Indian subcontinent. Diagnosis of eumycotic mycetoma on fine needle aspiration cytology (FNAC) is quick and helpful in early diagnosis and treatment of patient. Case Details: A 50-year-male presented with right foot swelling for 10 years, associated with discharge. On examination, 8x8 cm nodular swelling was seen extending from 3rd, 4th and 5th toe of right foot to mid foot. Overlying skin is discoloured and shows discharging sinus. FNAC of the swelling yielded pus-like material, along with black grains. Initial Papanicolaou, H and E and Giemsa stains showed the degenerated neutrophils, lymphocytes, histiocytes and multinucleated histiocytic giant cells with phagocytosed debris and cells with presence of occasional filamentous hyphae. Cell block preparation showed colonies containing radiating septate hyphae, highlighted on special stain GMS, and diagnosis of Eumycotic mycetoma was made. Further, timely surgical resection was performed based on cytodiagnosis of eumycotic mycetoma. Conclusion: Euycotic mycetoma can be accurately diagnosed by FNAC with cell block preparation, which is a simple, inexpensive, rapid technique and helpful in early Diagnosis.

   PP-066: Cytodiagnosis of Multilobulated Aggressive Angiomyxoma Clinically Mimicking Sarcoma – A Case Report Top

Junu Devi, Neeharika Phukan; Gauhati Medical College and Hospital, Guwahati, Assam, India

Introduction: Aggressive angiomyxoma is a rare but locally aggressive infiltrative mesenchymal tumour arising in the soft tissues of the lower genital tract. Incidence is very less (only about 350 cases have been recorded in the literature) with female to male ratio of 6:1. Average age at presentation is around 40 years. Case Report: A 32 years old female presented with multiple swelling in the vulval region for 1 and a half years associated with mild pain. The patient complains of dysmenorrhoea, pressure sensation, pelvic fullness, dyspepsia, weight loss and generalised weakness. She is married and has a 3 year old male child. Her menstrual cycle is regular with normal menses. FNAC of the vulval swelling was suggestive of ANGIOMYXOMA. The swelling was excised in the Gynaecological Operation Theatre and the specimen was sent to the Department of Pathology for Histopathological examination where it was diagnosed as Aggressive Angiomyxoma. On follow up, the patient is healthy with no complains of recurrence so far. Conclusion: Aggressive angiomyxoma is an aggressive tumour because it has a high risk of infiltration and local recurrence. Therefore, it should be distinguished from other myxoid tumours. Preoperative cytological diagnosis helps in surgical management with appropriate wide local excision with clear margins.

   PP-067: Cytological Diagnosis of Malignant Spindle Cell Sarcoma of Neck in a 35 Year Old Male – A Case Report and Review of Literature Top

Surbhi Rajauria, MMIMSR Mullana, Ambala, Haryana, India

Head and neck sarcoma are rare, accounting for about 1% of head /neck malignancies and 5-15% of adult sarcomas. Adult sarcoma in head and neck region 80% arise in soft tissue and 20% from bone and cartilage. Fine needle cytology is widely used in the diagnosis of neoplastic and non neoplastic lesion of soft tissue. This is a case report of malignant spindle cell sarcoma of neck in 35 yr old male confirmed on histopathology and immunohistochemistry.

   PP-068: Cytological Findings of Metastatic Pulmonary Neuroendocrine Carcinoma that Presented as a Brain Tumor Top

G Kiruthikasri, Adil Aziz Khan, Juhi Shahab, Priyanka Singh, Mukul Singh, Sachin Kolte, Sunil Ranga; Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Background: Brain is one of the rare sites for metastasis of neuroendocrine carcinoma, other sites being bone, liver and adrenals. The most frequent primary site of these tumors is gastrointestinal tract followed by the lungs. Very few cases have been reported on metastasis of neuroendocrine carcinoma to the brain and even more rarely they have been correlated with cytology. Case Summary: A 25-year-old male presented with complaints of giddiness and headache for 20 days. MRI revealed a mass lesion with mural based solid component measuring 56x57 mm in the left frontal lobe. Intraoperatively 15 ml red colored tumor cavity fluid was aspirated. Cytocentrifuge smears were cellular with numerous loose cellular aggregates, minimal pleomorphism, evenly dispersed chromatin, inconspicuous nucleoli with scant amount of cytoplasm along with atypical mitosis. Histopathology, revealed tumor cells arranged in nests showing moderate pleomorphism with many mitotic figures. On IHC, they were positive for synaptophysin and chromogranin and negative for pan CK, EMA, vimentin, LCA, PR, PLAP and GFAP. Secondary IHC panel showed focal weak positivity for Napsin-A while TTF-1 and CDX2 were negative. MIB-1 index was 80%. A diagnosis of metastatic neuroendocrine carcinoma with possibility of lung primary was made. On follow up, PET scan exhibited a primary lesion in the lung. Patient has undergone five cycles of chemotherapy with etoposide and is responding well. Conclusion: Brain metastasis of neuroendocrine carcinoma is a rare entity but the possibility of it should be borne in mind for accurate diagnosis.

   PP-069: Cytomorphologic Diagnosis of Clear Cell Sarcoma of Soft Tissues: Experience From a Tertiary Care Institute Top

Sananda Kumar, Parikshaa Gupta, Nalini Gupta; Post Graduate Institute of Medical Education and Research, Chandigarh, India

Introduction: Clear cell sarcoma of soft tissue (CCS-ST) is a rare high-grade, soft tissue sarcoma. Establishing a cytodiagnosis is challenging owing to its rarity, lack of awareness, and multiple morphologic mimics. Materials and Methods: This was a retrospective study conducted over 5 years. The cytopathology database was searched for all the cases reported as CCS-ST with immunocytochemical and/or histopathologic confirmation. All the cytomorphologic features were studied to identify characteristic features that can help in distinguishing it from its cytologic mimics. Results: There were 4 cases reported on cytology as CCS-ST with a mean age of 37.5 years and a male-female ratio of 3:1. Two (50%) presented with metastasis at presentation. All of these had been confirmed by ICC on the cell blocks with subsequent histopathologic confirmation available in 2 of these. FNA smears in all the cases were cellular with sheets of discretely scattered round to epithelioid tumor cells and loose clusters with traversing capillary channels in a vacuolated background. The tumor cells were mildly pleomorphic with round eccentric nuclei, fine chromatin, prominent nucleoli and moderate amount of finely vacuolated cytoplasm. On immunocytochemistry, tumor cells showed strong positivity for vimentin, HMB-45, S-100, Melan-A, and were negative for EMA, chromogranin, and MUM-1. INI-1 was retained. Histopathology showed similar morphologic features; however, in one case the tumor cells showed diffuse aberrant positivity for CD38 and CD138. Conclusions: Knowledge of the characteristic cytomorphological and immunocytochemical features of this entity is important to establish a prompt and accurate cytodiagnosis.

   PP-070: Cytomorphology of Melanocytic Nevus – Clues and Diagnostic Pitfall Top

Pratibha Gautam, Sandeep, Preeti Diwaker, Kalpana Sinha; UCMS and GTB Hospital, New Delhi, India

The cytomorphological spectrum for benign and malignant mesenchymal lesion is well known. However, the cytomorphological features for benign pigmented spindle cell lesions is scarce. Here in we provide detailed cytomorphological features of benign pigmented spindle cell lesion. A 26 year pregnant (second trimester) female presented in dermatology clinic with complaint of left sided buttock swelling since childhood which was gradually increasing in size for past 6 months. There were accompanying umblicated pearly papules in and around the swelling. On examination lesion was bluish globular, well defined, firm in consistency. In view of long standing gradually increasing lesion, clinician suggested Fine needle aspirate cytology of the lesion for definitive diagnosis. Aspirate was partly haemorrhage in consistency. Cytology revealed cellular smear comprising of loosely cohesive bland, spindle cell fragments along with numerous singly dispersed cells in background. These spindle cells displayed fine cytoplasmic projections with areas of significant black pigment deposition. However no nuclear atypia, mitotic figures and necrosis was seen. Based on above cytomorphological features, a cytological diagnosis of Benign pigmented spindle cell lesion was suggested and excision of lesion was advised for further characterization. Cytomorphological features in the index case provide clue to the diagnosis of benign pigmented spindle cell lesion in contrast to spindle cell melanoma.

   PP-071: Diagnostic Role of Cell Block In Cytopathology: Report of two Challenging Cases Top

Jai Kumar Chaurasia, E. Jayashankar, Shakti Kumar Yadav, Bharati Pandya; AIIMS, Bhopal, Madhya Pradesh, India

Background: The use of cell blocks have been widely advocated in FNAC of masses as they provide diagnostic information which complement FNA smears. Cell block enables visualisation of aspirate in tissue fragments, providing architectural information which sometimes is difficult to interpret on FNA smears and thereby improves diagnostic accuracy. Case Report: We report a case of a 35 year male who presented with swelling over left parietal region of scalp since 5 years. The swelling was firm, non-tender, adherent to overlying skin measuring 1.5x1 cm. FNA smears showed cohesive clusters, small sheets of benign epithelial cells focally admixed with metachromatic basement membrane-like material. A diagnosis of benign adnexal tumor was suggested. Cell block preparation shows a tumor composed of dual population of epithelial cells comprising of inner large cells with pale nuclei and outer small dark cells, separated by thick hyaline basement membrane diagnostic of cylindroma. 2nd case is of a 48 year male who presented with swelling over nape of neck since 1 year. The swelling was single, soft to firm, non-tender and slightly mobile. FNA smears shows abundant chondromyxoid stroma with few admixed fat cells with transgressing small capillaries. A diagnosis of benign adnexal tumor was suggested. Cell block preparation shows fat cells embedded in a predominantly myxoid matrix. A diagnosis of Myxoid Lipoma was suggested which was confirmed on histology. Conclusion: Cell block offer advantages over FNA smears as they provide both cytologic and architectural details and can offer diagnosis in challenging cases.

   PP-072: Elephantiasis Neuromatosa of Tongue Top

Pallavi Mehra; Department of Pathology, Patna Medical College and Hospital, Patna, Bihar, India

Introduction: Neurofibromas are benign nerve sheath tumors, consisting of schwann cells admixed with perineurial-like cells, fibroblasts, mast cells and CD34+ spindle cells. They most commonly present as superficial cutaneous nodules, solitary or multiple (NF-1 associated). Plexiform neurofibroma is usually pathognomic for NF-1. Here we present a case of isolated plexiform neurofibromas of tongue resulting in macroglossia in a 13 year old. Case Report: A 13 year female presented with complain of diffuse slow growing mass over tongue since a few months after her birth. On examination it had smooth external surface, firm consistency and an ulcer present over anterolateral aspect that bled intermittently. The mass had grown to considerable size resulting in macroglossia causing the patient difficulty in breathing, swallowing and speech. FNAC of the tongue yeilded blood mixed aspirate which on microscopy revealed spindle cells having scant cytoplasm, wavy nuclei with pointed ends. Histopathological examination revealed a circumscribed unencapsulated lesion composed of elongated spindle cells arranged against myxoid background. A thorough examination for similar lesion elsewhere in the body was negative. No café au lait spots, hearing deficit or any other systemic disorder was evident. Family history of similar lesion was negative. Discussion: Neurofibromas present either as solitary mass or as a part of neurofibromatosis syndrome. Plexiform neurofibromas most commonly are associated with the Neurofibromatosis syndrome. Macroglossia due to isolated plexiform neurofibroma, not associated with the neurofibromatosis syndrome is a rare entity.

   PP-073: Ewing'S Sarcoma in Scapula – A Rare Case Report Top

Apoorva Mathur, Nitesh Mohan, Anjana Arya, Vibhuti Goyal; Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India

Introduction: Ewing's Sarcoma is the second most common malignant bone tumor with male prepondance (M:F = 1.5:1), constituting 4%-10% of entire malignant osseous with peak incidence in second decade of life. It typically occurs in diaphyseal or metaphyseal region of long bones. Scapula is a rare site for Ewing's Sarcoma (3%), with an annual incidence rate of 2 per million. Ewing sarcoma arise more commonly in bones than soft tissue. Extraskeletal Ewing's Sarcoma is a rare, aggressive, malignant soft tissue tumor which accounts for 20–30% of all cases of Ewing's Sarcoma. Case Presentation: An 18 year old young male presented with ill defined, firm, tender swelling in the right scapular region measuring 11.8 x 11 cm for 6-8 months. A plain radiograph of the right shoulder joint revealed a dense soft tissue shadow around the joint, restricting its movement. FNAC displays large and small round to oval cells that are arranged singly and in sheets. Large cells are pale with abundant pale cytoplasm and small cells are dark with scanty cytoplasm with coarse chromatin and inconspicuous nucleolus and cells are arranged in a rosette-like pattern, suggestive of small round cell tumor. Above findings confirmed the diagnosis of small round cell tumor favouring Ewing's Sarcoma of right scapula with extraskeletal soft tissue involvement. Conclusion: Ewing's Sarcoma should be taken into account in the differential diagnosis of scapular malignancy even though scapular malignancies are rare.

   PP-074: Extracranial Metastasis of Intracranial Tumors: A Tale of Two Cases Top

W Vaishali, E Jayashankar, R Sumit, S Adesh, Mahabharathi, K Neelkamal; AIIMS, Bhopal, Madhya Pradesh, India

Background: Primary intracranial tumors in general and primary brain tumors rarely metastasize outside the cranial cavity. The scarcity literature has prompted us to report 2 cases of primary brain tumors which has metastasized to extracranial organs such as lymph node and scalp. Case 1: A 29 year female attended cytology clinic for gradually progressive swelling over scalp for 1 – 2 month. Two firm slightly mobile non tender swellings were noted, in parietal and occipital region of scalp measuring 5 x 3 cm and 2 x 2 cm respectively. FNA smears from the two swellings were cellular smears c/o small to intermediate tumor cells in group, clusters, pseudo- rosettes and singly dispersed cells. Mitotic activity was brisk. On detailed workup the patient revealed a history of embryonal tumor operated 9 month back. Case 2: Other case was a 27 year female diagnosed and operated for Nodular medulloblastoma & presented with complaints of two left level II cervical lymph node firm, immobile, non tender 3x2.5 cm and 0.8x0.8 cm respectively. Smears revealed malignant small round cells with pseudorosette formation and fibrillary material in the background. FNAC was suggestive of metastasis of medulloblastoma to cervical lymph node. Conclusion: Extracranial metastasis of brain tumor are albit rare & outcome is poor. Therefore the knowledge and awareness about the morphology in a proper clinical setting will help to clinch the cytological diagnosis & multidisciplinary approach for diagnosis is essential.

   PP-075: FNAC of Unilateral Thigh Mass: A Case Report with Elaborate Cytomorphological Differentials Top

Akanksha Kalita, Neha Singh, Prajwala Gupta; ABVIMS and Dr. RML Hospital, New Delhi, India

Alveolar soft part sarcoma (ASPS) is a rare tumour of deep soft tissue origin. It is more prevalent in young adults. The tumour has a slow moving clinical course, which frequently results in delayed detection and treatment. It is challenging to report on fine needle aspiration cytology (FNAC) since it is very vascular, can be mistaken for other entities such as hemangiomas and arteriovenous malformations clinically and radiographically. Therefore, understanding this entity and the differentials with its morphological mimics on FNAC is necessary for prompt diagnosis and early patient care. We describe a case of ASPS in a young woman who had a significant, painless swelling in her thigh with clinico-radiological diagnosis of high flow vascular malformation which was identified on FNAC with combined ancillary testing.

   PP-076: Granular Cell Tumour of Tongue: A Case Report Top

Junu Devi, Ekaparna Hazarika; Gauhati Medical College and Hospital, Guwahati, Assam, India

Introduction: Granular cell tumor is a rare lesion which accounts for approximately 0.5% of all soft tissue tumors. Most of the tumors occur in head and neck region, especially in the tongue, buccal mucosa and palate. Case Report: A 21-year old female presented to the ENT OPD of Gauhati Medical College & Hospital, Guwahati, complaining of a painless, progressive swelling on the right lateral border of the tongue for 2 years. Cytological examination revealed loose clusters of round to polygonal cells with moderate to abundant eosinophilic granular cytoplasm and eccentric round nuclei in an inflammatory background. The patient underwent local excision of the swelling and the specimen was sent for histopathological examination. Microscopic examination revealed a circumscribed lesion comprising of sheets of granular cells having abundant eosinophilic cytoplasm with small, round nuclei, intermingled with collagen fibres. Focal area showed acanthosis of the overlying epithelium. On IHC, the tumor cells showed positive cytoplasmic staining for S100. The case was diagnosed as Granular cell tumor of tongue. Discussion: Granular cell tumor presents as a non-tender, firm, slow-growing mass. Granular cells often occur in ribbons separated by fibrous septa, giving the appearance of “invading” into underlying tissues. The tumor shows PAS positive Diastase resistant cytoplasmic granules. The tumour cells are positive for S100, NSE and CD 68. Differential Diagnosis include Congenital Granular cell Epulis, Adult Rhabdomyoma, Granular Cell Ameloblastic Fibroma. Conclusion: The treatment of choice for granular cell tumor is surgical excision. Recurrence of tumors in cases of incomplete excision have been seen.

   PP-077: Incidental Finding of Microfilaria in a Case Of Myeloid Sarcoma – A Case Report Top

Paramita Mandal, Nikhil Kumar, Gargi Mukherjee, Jitendra Kumar Sinha, Debarshi Saha, Ranwir Kumar Sinha; AIIMS, Deoghar, Jharkhand, India

Filariasis is a major public health problem in tropical and subtropical countries & it is one of the common endemic diseases in India. Microfilaria has also been reported in association with various benign & malignant tumors. Here we report a case of incidental finding of microfilaria in myeloid sarcoma over the lower back in a 38 years old male patient. MRI finding of swelling over the back was suggestive of inflammatory condition/necrotic sarcomatous lesion. Fine needle aspiration shows microfilaria of Wuchereria bancrofti along with plenty of immature granulocytic cells. Subsequently CBC was done and findings were suggestive of CML in chronic phase which was confirmed BCR-ABL1 positive cytogenetically. Patient was treated with Imatinib, Diethyl Carbamazine and Ivermectin and on further follow up swelling got disappeared. Presence of microfilaria in FNA smears of myeloid sarcoma associated with CML in chronic phase is very rare.

   PP-078: Intramuscular Myxoma of Thigh: A Case Report Top

Prachi Chaudhary, G D Katiyar

Intramuscular myxoma is a rare benign tumour involving the musculoskeletal system. The most common sites are thighs, shoulders, buttocks and arms. Most patients present between 40 to 50 years of age. In this case we report a swelling present on left thigh of a 70 year old female. The swelling was 6x5 cm in size, painless, firm, mobile and gradually increasing in size. Initially fine needle aspiration cytology was done which yielded a thick gelatinous material. Differential diagnosis of (1) benign myxoid lesion; (2) ganglion cyst and (3) gouty tophi was made. It was further confirmed by histopathological examination after excision in toto. Histopathological evaluation reported it to be a confirmatory case of intramuscular myxoma of thigh. This case is reported here because this tumour is rare.

   PP-079: Langerhans Cell Histiocytosis Diagnosed on Cytology and Confirmed on Histopathlogy – Case Report Top

Vartika Mishra, Saurabh Shrivastava, Sudha Iyengar, Rajesh Gaur; Gajraraja Medical College, Gwalior, Madhya Pradesh, India

Langerhans cell Histiocytosis is a rare disease with incidence of 3 - 5 cases per million children. We report a 2.6 years old male child who presented to the cytology section of our department with gradually increasing frontoparietal swelling measuring 3x3x2 cm. Computed tomography of the head showed osteolytic lesion in left parietal and right frontal bones. Patient had history of similar bone lesion at the level of L3 vertebrae which was empirically treated. A probable diagnosis of Langerhans Cell Histiocytosis was made on cytology in which smears showed histocytes, eosinophils and neutrophils in hemorrhagic background. Later biopsy was sent in histopathology where diagnosis was confirmed. On follow up, patient expired within 4 months of diagnosis.

   PP-080: Metastatic Deposits of Mucinous Adenocarcinoma in the Skin of Unknown Primary Top

Mollika Kutum, Pranita Medhi, Swagata Dowerah; Assam Medical College and Hospital, Dibrugarh, Assam, India

Background: Mucinous adenocarcinomas (MACs) are a group of malignant tumours, originate from epithelial tissue and characterized by abnormal mucus secretion. MACs are commonly observed in colorectal cancer but can also occur in other organs, such as breast, stomach, ovary, pancreas, appendix and lung. MACs of various origins may have a similar histologic appearance and frequently metastasize to distant sites, which often causes diagnostic problems in surgical pathology practice. Case Report: A 41 yrs old female with skin nodules in the right iliac region at surgical site since 1 year, transformed into ulcerative and fungating growth in last 3 months. Patient was operated in 2019 for some pelvic lesion however no documentation available. No history of pain and fever. CECT whole abdomen reveals intraperitoneal abscess. On examination- swelling of size 5x4x3 cm, soft to firm and slightly mobile. FNAC revealed cellular smears comprising of round to oval cells in clusters as well as in acini pattern with cellular pleomorphism, coarse nuclear chromatin, prominent nucleoli, moderate amount of cytoplasm in a mucinous background. Cytological diagnosis was myxoid tumor/metastatic mucinous adenocarcinoma. HPE confirmed the diagnosis of Metastatic mucinous adenocarcinoma. Conclusion: The myxoid/mucoid neoplasms include chordoma, myxopapillary ependymoma, metastatic mucinous adenocarcinoma and extra skeletal myxoid chondrosarcoma. Despite the similarity of the background substance, each of these has characteristic morphologic features. Since many of these masses are not surgically biopsied, FNAC is often use for their diagnosis.

   PP-081: Perplexity of a Lytic Bone Lesion: Intraosseous Epidermal Cyst Masquerading as a Bone Tumor Top

Akanksha Agrawal, Saurabh Goswami, Pragya Jain, Preeti Diwaker, Vinod Kumar Arora; UCMS and GTB Hospital, New Delhi, India

Introduction: Epidermal cysts are slowly growing intradermal or subcutaneous tumors. Intraosseous epidermal cyst is a rare occurrence, mostly affects small bones of hand and skull bones. We present a case of intraosseous epidermal cyst of distal phalanx diagnosed by FNAC, masquerading clinically and radiologically as a bone tumor. Case Report: A 28 years old male presented with swelling of tip of right 4th finger. He gave history of trauma to the finger. X-ray of right hand showed a lytic lesion of distal phalanx of the 4th finger and was diagnosed as giant cell tumor of bone. USG guided FNAC was done from the lytic lesion and aspirate yielded pultaceous material. MGG and PAP stained smears showed numerous anucleate squames. Considering clinical, radiological, and cytological findings a diagnosis of intraosseous epidermal cyst was made. Conclusion: Although intraosseous epidermal cysts are rare occurrence, they can be found in skull and distal phalanges and can be definitively diagnosed on FNAC. Intraosseous epidermal cyst should be considered in differential diagnosis of radiolucent lytic bony lesions.

   PP-082: Role Of Cytology in the Diagnosis of Ewing Sarcoma Top

Bhoomika Kaushik

Background: Ewing Sarcoma, second most aggressive tumor of childhood and adolescent age groups can affect bone and soft tissue. Long bone diaphysis and flat bones are most common affected site by the Ewing sarcoma. Although Fine needle aspiration is a quick procedure but has very limited role in the diagnosis of Ewing sarcoma preoperatively. Here we are reporting a case series of Ewing sarcoma in AIIMS Rishikesh within one year. Aim and Objectives: To establish the role of cytology in the diagnosis of intraosseous as well as extraosseous Ewing Sarcoma. Materials and Methods: A total 14 cases were retrospectively studied over a period of one year from 1 September 2021 to 30 August 2022 in Department of Pathology and lab medicine, AIIMS Rishikesh. All fnac samples and corresponding core biopsy are included in this study. Results: Total 14 cases studied, 8 were male and 6 were female and all these are immunohistochemistry proven Ewing Sarcoma but out of these 14 cases for only one case we received imprint cytology. Conclusion: The findings of our study suggest that in the diagnosis Ewing Sarcoma, role of cytology is very limited as aspirations and imprints are very infrequently send. Cytological features may overlap with other small and large cell tumors. Hence histopathological findings also demand attention along with other ancillary investigations such as immunohistochemistry to confirm the diagnosis.

   PP-083: Parasitology in Pathology Top

P Divya

Parasitology is a less explored arena. An accurate microscopic diagnosis benefits the patient by avoiding overtreatment and inappropriate treatment, so an emphasis on this part is necessary. The modalities for diagnosis of parasites in various samples are wide but basic investigations like blood smear examination and QBC are helpful in diagnosing the most.

   PP-084: Cytopathological Profile of Ultrasound Guided Fine Needle Aspiration Cytology of Lesions in Patients Attending Tertiary Care Hospital: A Record Based Study Top

K L Shoba, Mandya Institute of Medical Sciences, Mandya, Karnataka, India

Background: Fine needle aspiration cytology (FNAC) is a simple investigation for the preoperative diagnosis of palpable, non palpable, deep seated lesions of various organs with the increased sophistication of radiologic imaging techniques. A confirmed diagnosis is essential for both treatment and staging of cancers. The present study was undertaken to critically analyse the usefulness of ultrasound guided FNAC in the diagnosis of various abdomino-pelvic, thoracic, head and neck and impalpable lesions. Objectives: (1) To describe the cytological features of deep seated, inaccessible, impalpable lesions through USG guided FNAC. (2) To describe common site and demographic profile of patients. Methodology: This was a retrospective record based 5 year study conducted from January 2017 to December 2021. Results: Among a total of 334 cases, 55% were females and 45% were males.130 were malignant and 95 were benign and 109 were other lesions. 116 (34.7%) were thoracic lesions, 149 (44.6%) were head and neck lesions, 13 (3.9%) were retroperitoneal lesions, 42 (12.6%) were abdomino pelvic lesions and 14 (4.2%) were bone and synovial lesions. In thoracic lesions, 65 (56%) cases were from lung and among that 15 (23.1%) were squamous cell carcinoma. In head and neck lesion, 68 (45.6%) cases were from cervical lymph node and among that 18 (31%) were metastatic squamous cell carcinoma. In retroperitoneal lesions, one case of DLBCL of spleen and metastatic squamous cell carcinoma of para aortic lymph node each. In abdominopelvic lesions, 16 (40.5%) cases were from liver, among that 4 (25%) were hepatocellular carcinoma. Both the sensitivity and specificity were 100%. Conclusion: USG guided FNAC is a minimally invasive and safe diagnostic procedure for the diagnosis of deep-seated, inaccessible, impalpable lesions, thereby avoiding expensive and aggressive diagnostic procedures leading to less morbidity and mortality and treatment can be started early.

   PP-085: Metastatic Glioblastoma in Cervical Lymph Node Diagnosed by FNAC Top

Nisha Marwah, Sumiti Gupta, Vibhav Goel, Ishwar Singh, Sunita Singh; Pt. BDS PGIMS, Rohtak, Haryana, India

Background: Glioblastoma is an aggressive tumor of CNS with poor prognosis. However, extracranial metastasis are very rare and are seen most commonly with procedures such as repeated craniotomies, thus giving the glioma cells access to extrameningeal structures. Case Report: A 22 year old male presented in ENT OPD with complaints of multiple swellings in the left cervical region since 10 days associated with difficulty in swallowing and change of voice. No history of fever, cough, or T.B. contact was there. However, patient gave a surgical history of having undergone Left Frontal craniotomy with tumour decompression 2 years back. Excised intracranial mass was diagnosed as Glioblastoma multiforme (GBM) on histopathological examination. FNAC was done from cervical swelling left side, measuring 2×1.5 cm and yielded blood- mixed aspirate. Smears examined revealed atypical cells having round to oval to spindle shaped irregular nuclei with focal nuclear overlapping, and moderate amount of ill defined at places, cytoplasm. The atypical cells were seen embedded in eosinophilic fibrillary material in a background of RBCs and lymphoid cells. Cytological findings were positive for malignancy favouring metastatic deposits from Glioblastoma multiforme. Conclusion: Extraneural metastasis from GBM are rare despite its being a highly malignant tumour. The cytomorphological features of Glioblastoma are distinct, with pleomorphic cells in loosely cohesive clusters with prominent nucleoli, coarsely clumped chromatin and cellular processes. FNAC along with clinical history is a cost effective, safe and time saving, fairly accurate method for diagnosing Glioblastoma which can be further aided by cell block and immunocytochemistry.

   PP-086: Categorisation of LBC Smears of Lymph Node Aspirates According to the Sydney System Top

Pooja Verma, Kavya Varshney, Sana Ahuja, Mukul Singh, Sunil Ranga; 1Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, 2Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Background: The Sydney system standardizes the reporting of lymph node aspirates under five categories- Non- Diagnostic (L1), Benign (L2), AUS/ALUS (L3), suspicious (L4), malignant (L5). Fine needle aspiration along with LBC is a reliable technique for diagnosis of lymphadenopathy. The study aimed to classify LBC smears of lymph node aspirates according to the newly proposed Sydney System. Methods: 50 lymph node aspirates were evaluated and classified according to Sydney system. Ancillary techniques, immunohistochemistry and flowcytometric immunophenotyping were utilised whenever needed. Results: The 50 lymph node aspirates were classified as follows- ND, 2 (4%); NFM, 28 (56%); AUS, 2 (4%); SFM, 8 (16%) and malignant 10 (20%). Majority (84%) were from cervical lymph nodes including submandibular lymph nodes while 10% from axillary and 6% from inguinal lymph nodes. The age of the patients ranged from 7-68 yrs with mean age of 39.6 years. Conclusion: The Sydney system is an excellent system for classifying lymph node aspirates with greater reproducibility of reports and better communication between pathologist and clinician.

   PP-087: Diagnostic Role of Cell Block in Metastatic Lymphadenopathy of Head and Neck Region – A One Year Study Top

Sudipta Das, Adity Sharma, Aseema Das; Assam Medical College and Hospital, Dibrugarh, Assam, India

Background: Fine needle aspiration cytology (FNAC) of the lymph nodes is efficient in diagnosing the etiology of enlarged lymph nodes in most of the cases. However, sometimes it does not provide sufficient information for accurate diagnosis and so there is a risk of false negative diagnosis. To overcome these problems, cell block techniques are used. Aim: To evaluate the diagnostic role of cell block in metastatic lymphadenopathy of head and neck region. Materials and Methods: This 1 year study was done in the Cytology section of the Department of Pathology, Assam Medical College & Hospital on the cases that were referred for FNAC of lymph node swellings in the head and neck region. The sensitivity, specificity and diagnostic accuracy were calculated using SPSS 16.0, taking histopathology as the Gold Standard. Results: The distribution of 81 cases as per Sydney System Category were: inadequate material 15%; benign 48%; atypical 4%; suspicious for malignancy 6% and malignant 27%. When only metastatic lesions were considered as positive, the sensitivity, specificity and diagnostic accuracy of cell block were 93.5%, 96% and 95% respectively. Conclusion: Cell block method is simple to perform and requires less expertise comparatively to handle the specimen. It allows the processing of minute amounts of cellular material and in classifying the tumor better when reviewed along with cytological smears. Therefore the routine preparation of the cell block improves the accuracy of FNAC diagnosis.

   PP-088: Fine-Needle Aspiration Cytology as a Tool for Diagnosis of Anaplastic Large Cell Lymphoma Top

Nagarjun Sai, Meenakshi Rao, Divya Aggarwal, T Balamurugan, Siya Ram Didel, Vikrant Verma, Taruna Yadav; AIIMS, Jodhpur, Rajasthan, India

Introduction: Anaplastic large cell lymphoma is a T-cell lymphoma accounting for <5% of Non Hodgkin's lymphoma, having an aggressive course and is usually diagnosed on excisional biopsy. Diagnosis of ALCL in fine needle aspiration cytology (FNAC) and cell block preparation is as accurate as in histopathology. Herein, we report a case of ALCL diagnosed on FNAC. Case Details: A 7 year-male, presented with generalized lymphadenopathy for 3 months and fever for 20 days. CECT showed lytic lesions in frontal bone, mandible, bilateral proximal humerus and ribs. Direct palpation-guided FNAC performed from right cervical lymph node showed predominantly singly dispersed atypical cells, along with loose clustering of cells. These atypical cells are intermediate to large sized (2.5-3 times the size of small mature lymphocytes), with moderate basophilic cytoplasm, round to oval nucleus with irregular nuclear membrane, with indentations & cleaving, fine chromatin & prominent 1-4 nucleoli. Occasional binucleated cells & few mitotic figures are also seen. Immunohistochemistry was performed on cell block in which the atypical cells showed positivity to EMA & CD30. These cells are negative for CD20, CD3, CD79a, CD1a, S100P, & panCK. A diagnosis of Anaplastic large cell lymphoma was established which was later confirmed on excisional biopsy too. Conclusion: Despite the wide morphologic spectrum of ALCL, a definitive diagnosis on the basis of FNA cytology is possible on careful interpretation of the cytologic features and a high index of suspicion. The cytologic diagnosis can be confirmed further with proper application of immunostaining on cell block sections.

   PP-089: Granulomas-Look Beyond Top

Priyathersini Nagarajan; Sri Ramachandra Medical College, SRIHER, Chennai, Tamil Nadu, India

Introduction: Granulomas are chronic inflammatory response seen in many infections, autoimmune conditions, toxins and neoplasms. In cytology it poses a challenge in the diagnosis of the underlying neoplasm. We report this case to emphasis to look beyond the granulomas for identifying the neoplastic process. Case History: A 45- year female patient presented with complaints of pain in the right hip radiating to right leg for 3 months duration. On examination there was an abscess in the gluteal region. MRI imaging showed diffuse altered signal intensities in spine and pelvic bones, suggestive of infection, tuberculosis most likely than metastasis. PET CT showed FDG avidity seen within vertebra with associated extraosseous soft tissue density mass seen along lower lumbar vertebra. Enlarged lymph nodes with increased FDG uptake was seen in right inguinal and bilateral external iliac nodes. FNAC of the inguinal nodes showed multiple granulomas with scattered atypical lymphoid cells in the background. Biopsy from the gluteal abscess and the para vertebral mass showed dense acute inflammation with admixed similar atypical cells. Immunohistochemistry work up showed atypical B lymphoid proliferation suggesting a high- grade non- Hodgkin lymphoma. Patient was started on chemotherapy and showed improvement. Discussion: Lymphoid neoplasms, Hodgkins and Non-Hodgkins lymphomas are known to show granulomatous inflammation. The identification of the neoplasm is challenging in fine needle aspiration cytology when the granulomas obscure the malignant cells. Therefore, it is important to consider neoplasms, such as DLBCL, as a differential diagnosis when encountering granulomatous inflammation on cytology.

   PP-090: Metastatic Embryonal Rhabdomyosarcoma on FNAC Top

Annmy Jose, Sherrin Jacob, Neeti Nagar, Mukul Singh, Sunil Ranga; Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Introduction: Amongst soft tissue sarcomas, rhabdomyosarcoma is the most common among children and adolescents with embryonal variant of rhabdomyosarcoma being common between 3-9 yrs of age. Aim: To show the importance of ancillary techniques aiding in the diagnosis of rare entities as metastasis of Rhabdomyosarcoma. Case: A 9 yr old girl presented with left supraclavicular lymph node swelling since 4 months. FNAC followed by giemsa stained smears showed high cellularity with variably pleomorphic round blue cells with moderate amount of cytoplasm and tiny cytoplasmic vacuoles in some cells, high N:C ratio, irregular nuclear membrane, open chromatin with inconspicuous nucleoli. Differential diagnosis in this case included small round cell tumors like rhabdomyosarcoma, Ewings, neuroblastoma, lymphoma with the possibility of Ewings and neuroblastoma being ruled out on cytomorphology. The patient also had a right forearm swelling and axillary mass for 6 months, with forearm swelling reported as malignant round cell tumour, likely embryonal rhabdomyosarcoma on biopsy which was positive on IHC for vimetin, desmin, myogenin. Flowcytometry on CD45 was done to rule out lymphoma which came out to be negative and the case was reported as metastasis of embryonal rhabdomyosarcoma. Results: This case was reported out as suggestive of metastatic deposit of embryonal rhabdomyosarcoma, left supraclavicular lymph node after excluding other differentials. Conclusion: Ancillary techniques such flowcytometry in FNAC are a reliable diagnostic modality in helping reach the interpretation of cases like metastatic embryonal rhabdomyosarcoma in lymph node which is quite rare.

   PP-091: Monday Blues in Mediastinal Lymph Nodes! Top

M Arthi, N Priyathersini, Leena D Joseph, Sandhya Sundaram, Sri Gayathri, Irfan; Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Chronic lymphocytic leukaemia is the most common peripheral B cell lymphoma affecting most commonly the cervical group of lymph nodes. Mediastinal group of lymph node involvement is rare. This is a case of a 60 year old male who complained of fever and cough on and off associated with loss of weight. Patient also had hepatoslenomegaly on evaluation. CT thorax revealed mediatinal lymph node enlargement; hence tuberculosis was the provisional diagnosis. Mantoux test was done which was positive. Peripheral smear examination revealed the diagnosis of CLL/SLL, which was further confirmed with flow cytometry. Since mantoux test was positive, mediastinal lymph nodes were evaluated by EBUS procedure to rule out tuberculosis. A total of six passes were made at the carinal lymph nodes. The FNAC slide of the same showed sheets of monomorphic small round blue cells and no evidence of granulomas. Biopsy also confirmed the diagnosis of CLL/SLL in the mediastinal lymph nodes. This is a rare presentation of a patient being evaluated for tuberculosis with mantoux positivity who also had a underlying CLL, turned out to be a mediastinal involvement of CLL.

   PP-092: Penile Acantholytic Squamous Cell Carcinoma Simulating Melanoma: A Diagnostic Pitfall on Cytology Top

Kavita Gaur

Introduction: Acantholytic squamous cell carcinoma (ASCC) is an infrequent subtype of SCC. This tumor variant being rare in itself, is even rarer at the penile location. Hence, information on pathological findings and prognosis is limited. Case History: A 65-year-old male presented with a ulcero-proliferative growth, arising from the glans penis with bloody discharge for 4 years along with right inguinal lymphadenopathy. FNA from right inguinal lymph node revealed highly cellular smears showing malignant cells in solid sheets, cohesive groups and singly dispersed. Nuclei were ovoid showing moderate pleomorphism with coarse chromatin. Plasmacytoid forms were seen along with atypical mitotic figures. Based on cytological examination, a possibility of metastatic SCC and amelanotic melanoma were considered. Subsequently, Partial penectomy was done and submitted for HPE. Sections revealed a diffusely infiltrative tumor with similar morphology and extensive dyscohesion. IHC showed positivity for p63, CK 5/6, vimentin and was negative for S-100 and Melan-A. A final diagnosis of ASCC was rendered. Discussion: Morphology in this case is highly unusual with cells showing plasmacytoid morphology making a cytological diagnosis extremely challenging as FNAC from the genital site and compliance for a repeat sampling was not possible for cell block preparation in this case, making the diagnosis tougher. Close D/Ds suggested was possibility of melanoma. However alone may prove to being inadequate for rendering a conclusive diagnosis. Conclusion: With a diagnosis of ASCC, the clinicians should consider an aggressive, multidisciplinary treatment and a close follow-up with multimodality imaging to improve long term survival and patient outcomes.

   PP-093: Solitary Plasmacytoma in a Middle-Aged Man in an Unusual Location Top

Jaya Bagchi (Samaddar), Rupsha Dutta (Pal), Bidyut Krishna Goswami; North Bengal Medical College, Siliguri, West Bengal, India

Introduction: Solitary plasmacytoma is defined as a single localized tumour consisting of monoclonal proliferation of plasma cells with no clinical features of plasma cell myeloma and no physical or radiological evidence of additional plasma cell tumours. To the best of our knowledge adult solitary plasmacytoma is very rare. Clinical Presentation: A 52 years old male attended the general OPD of NBMC with chief complaint of right inguinal swelling for 3 years. On palpation no lymph nodes were palpable. There was no bony tenderness. Both right and left testes were normal. No organomegaly was found. Investigations: Radiological (Chest Xray, USG and CT abdomen) and Haematological examination (PBF and BM examination)- normal study. Procedures Done: On Physician's advice FNAC (Aspirate: Dense granular) was done followed by cell block preparation and H&E stained sections were examined. Microscopy: FNAC – Smears showed round to oval monomorphic cells in loose clusters and in singles, having central to eccentric nuclei often with prominent nucleoli and eosinophilic cytoplasm. Plasmacytoid appearance and bi/multinucleation were often noted. Background contained degenerated material. Cell block- Sections showed sheets of uniform small to medium sized plasmacytoid cells with eccentric nuclei, prominent central nucleoli and abundant cytoplasm. Some cells were with opened up chromatin and central nuclei. Bi/multinucleated cells were also seen. Discussion: Having clinical scenario of solitary inguinal swelling without any haematological/ biochemical/radiological abnormality along with FNAC and cell block opinion, soft tissue solitary plasmacytoma was our provisional diagnosis which was later confirmed by IHC.

   PP-094: Fine Needle Aspiration Cytology of Lymph Nodes – Is it a Boon? Top

Vartika Mishra, Sudha Iyengar, Rajesh Gaur; Gajra Raja Medical College, Gwalior, Madhya Pradesh, India

Fine needle aspiration cytology is a simple and rapid diagnostic procedure to identify etiology in an enlarged lymph node. Aim: We studied malignant lymph nodes. Most common site aspirated, age & sex distribution and spectrum of diagnosis was presented in our result. Methods: We retrospectively reviewed malignant lymph node aspirates over a period of three years from June 2019 to May 2022 in Department of Pathology, Gajraraja Medical College, Gwalior, India. We excluded tubercular and reactive lymph nodes. Results: A total of 1026 lymph node were aspirated. 198 cases (12.1%) were identified as malignant. Age distribution was 5-88 years. Male to female ratio was 5.8:1. In metastatic lymph nodes Cervical lymph nodes (174/201; 86.56%) were the main group.173 cases (86%) showed metastatic deposits which was more common compared to 28 cases (13.9%) of primary lymphomas. Malignancies, included 143 cases (71.1%) of SCC (metastasis) and 22 cases (78.5%) of Non Hodgkins lymhoma. Conclusion: Cervical lymph node was the most common malignant node aspirated. Squamous cell carcinoma and Non Hodgkins lymphoma were the most common primary and secondary malignancies. FNAC is a one-step routine OPD procedure as mostly lymph nodes are easily accessible and can be reported within 5 days thus saving time and reducing discomfort of biopsy. Majority of benign etiologies can be triaged, focusing more on malignant cases. FNAC thus proves to be a boon for diagnosing lymph node malignancies.

   PP-095: Spectrum Of Cytological Diagnosis in Axillary Lymph Node Enlargement – A 2 Year Retrospective Study in a Tertiary Care Hospital Top

Bhargav Mohan, Adity Sharma, Aseema Das; AMCH

Axillary lymphadenopathy is one of the most common presentation seen in patients attending the outpatient department in most of the hospitals. FNAC is the most reliable, safe, easy and accurate method helping is diagnosis and to differentiate benign from malignant lymphadenopathy. Materials and Methods: The present study was conducted for 2 years retrospectively in a tertiary care hospital including all the cases presenting with axillary lymph node enlargement in the Department of Pathology. The data were retrieved, compiled, summarised and statistically analysed. Results: Out of 72 cases, 51.4% are males, 49.6% are females with 58.3% of cases presenting left axillary lymphadenopathy. The most common findings is metastatic (27.7%), followed by reactive lymphadenitis (19.5%) and least common is lymphoproliferative disorder (LPD) 8.4%. Conclusion: FNAC is a rapid, less invasive, less traumatic, and easily accessible and a cheap diagnostic tool to diagnosis most of the axillary lymphadenopathy. It also helps to differentiate benign lesions from malignant with less false negative results.

   PP-096: Detection of Primary Site of Malignancy From Pleural Effusion Fluid with Help Of Cell Block and IHC – A Case Report Top

Syed Ashik Rahaman, Anuradha De (Pati), Arindam Karmakar; Calcutta National Medical College and Hospital, Kolkata, West Bengal, India

Background: Diagnosis of unknown primary poses a challenge for clinicians and diagnosticians not only in India but all over the world. Hence presence of a malignant pleural effusion with no known primary is a riddle that is hard to solve despite many recent advances in oncology. The common etiologies of Malignant pleural effusion are lung cancer, lymphoma/leukemia and breast cancer. Cell block preparation, immunohistochemistry and biomarker study may be helpful in diagnosing the primary site. Case History: 71 years old female patient presented with history of dyspnea, right sided chest pain, with h/o gradual weight loss since last 4 months. She had no such previous h/o comorbidity detected. Breasts were normal clinically. No palpable lymph node was found on clinical examination. On local examination, huge right sided pleural effusion noted. Chest X- ray finding showed collapsed lung along with massive pleural effusion at right side. Routine blood examination revealed normocytic normochromic anemia and neutrophilic leukocytosis. Cytology of pleural fluid showed presence of malignant cells. Then cell block was prepared for IHC and there was positive staining for CK7, TTF-1, NAPSIN–A while CK20, CALRETININ was negative. PETCT after drainage of pleural effusion was able to detect a lung lesion. Later on CT guided Trucut biopsy proved Adenocarcinoma Lung. Conclusion: Although detection of primary site is vital for a patient with metastatic disease, it is neither straight forward nor is possible for all the cases. However, use of all the tools available may be able to resolve the crisis in many cases and save lives. The case presented here is a successful example where the primary could be detected with the help of immunohistochemistry.

   PP-097: An Unusual Journey of Paediatric Hodgkins Lymphoma in a Teenage Boy Top

Ruchira Palmal, Rahul Satarkar, Ashish Gupta, Sunil Jondhale, Anil Goel, Aishwarya John

Hodgkin lymphoma is B cell malignancy that represents 11% of the lymphomas. Patients usually present with B symptoms. Pericardial involvement in Hodgkin lymphoma is seen in 5% of the cases and is usually asymptomatic. Initial pathologic diagnosis can be achieved by pericardial fluid analysis as happened in the present case. Here we present a case of 13-year-old boy who presented with fever, cough and breathlessness. O/e: there was muffled heart sound and decreased air entry. CT thorax showed large ill defined, soft tissue density lesion involving anterior mediastinum. Echo revealed large pericardial effusion, with impending cardiac tamponade with ejection fraction of 70%. Pericardial fluid was sent for cytology. Cell block and cytological examination show high cellularity with presence of eosinophils, lymphocytes, and mononucleated and binucleated R-S like cells which were positive for CD 15 and Fascin1 on immunohistochemistry. So, the possibility of Hodgkin lymphoma was considered and on biopsy the diagnosis was confirmed further. As per GLOBOCAN data 2020, incident cases of Hodgkin lymphoma in India 0-14 age group is 1209 cases per year. Pericardial involvement in Hodgkin lymphoma is the serious manifestations of advanced malignancy. In this case patient presented with features of cardiac tamponade. Initial cytological examination of pericardial fluid showed a path to plan the further investigations and we arrived at the final diagnosis of Hodgkin lymphoma on supraclavicular lymph node biopsy. This case is being presented to highlight the unusual pericardial involvement Hodgkin's lymphoma. A careful search in visceral effusions should be made by pathologist in suspected cases.

   PP-098: Cerebrospinal Hemophagocytic Lymphohistiocytosis: Stalking the Diagnosis Top

Kalpana Kumari, Himadri Hazarika, Preeti Diwaker; UCMS and GTB Hospital, New Delhi, India

Introduction: The differential diagnosis for vacuolated macrophages displaying hemophagocytosis in CSF is broad. Diagnosing CNS-hemophagocytic lymphohistiocytosis (HLH) requires multimodal approach including clinical, laboratory, neuroimaging, and molecular findings. Case Report: A 22-year female, non-diabetic, non-hypertensive gave birth to her first low birth weight (1.5 kg) baby by LSCS. Ten days later baby got admitted in NICU in view of reversed end diastolic flow on Doppler. The baby had respiratory distress at birth and was put on pressure support. Baby had repeated episodes of hypoglycaemia and was administered glucose infusion. Still, the baby had on and off asymptomatic hypoglycaemic episodes. Physical examination revealed ambiguous genitalia and workup for congenital adrenal hyperplasia was planned. Buccal smear examined showed Barr body of 4%. No hepatosplenomegaly and blood culture were sterile. CBC; haemoglobin of 21 g/dl, TLC: 41600/cumm and thrombocytopenia (9900/cumm). A lumbar puncture was done on day 10 to rule out meningitis and the CSF sample was sent for analysis and cytology. CSF examination revealed a TLC of 300 cells/cumm with predominance of polymorphs including population of large cells with abundant cytoplasm and eccentric nuclei cells. CSF cytology revealed numerous histiocytes displaying foamy cytoplasm, cytoplasmic pigment along with evidence of emperipolesis (macrophages engulfing neutrophils and erythrocytes) and numerous neutrophils admixed with RBC's. Later, follow-up revealed abdominal tuberculosis in the mother and subsequently she was started on ATT. Conclusion: CSF cytology along with other clinico-radiological findings, contribute to diagnosis of CNS- HLH. Atypical CSF presentation should alert physician to rule out an underlying cause of HLH.

   PP-099: Isolated Extramedullary Lymphoid Blast Crisis in a Known Case of Chronic Myeloid Leukaemia Top

A Mohapatra, S K Hota, P Pradhan, P Das, N Sahu, R Panigrahi, U Senapati, J Pattnaik; Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India

Introduction: Chronic Myeloid Leukaemia (CML) is a clonal stem cell disorder characterized by formation of Philadelphia chromosome. Blast phase of CML is defined either by the presence of ≥ 20% blasts in the peripheral blood/bone marrow or alternatively by the focal accumulation of blasts in the extramedullary site(s). Isolated blast crisis of CML involving central nervous system is rare. Here we present a case of isolated lymphoid blast crisis involving CNS in a known case of CML. Case Report: A 27 year old female, diagnosed case of CML (BCR-ABL+, p210+) was on imatinib for last 6 months. Now she presented with diminished vision for one month. She had fever, vomiting, irritability and altered sensorium for last 2 days. On examination, she had mild pallor, mild splenomegaly, bilateral proptosis and neck rigidity. Fundoscopy findings were suggestive of chronic papilledema with leukemic retinopathy. Peripheral blood examination showed pancytopenia without any atypical cell. MRI findings were suggestive of CSF spread of CML. CSF analysis showed markedly high cell count with plenty of large atypical cells suggestive of leukemic infiltration. Bone marrow was hypocellular with 2% blast cells. Flow cytometry of CSF sample was suggestive of B- lymphoblastic leukaemia. So, a diagnosis of lymphoid blast crisis involving CNS was made. Conclusion: Patients of CML on treatment can present with isolated extramedullary blast crisis. One should keep this in mind during follow up of CML, specially when patient presents with non haematological manifestation.

   PP-100: Malignant Pericardial Effusion in Carcinoma of the Cervix, Presenting at a Tertiary Care Centre.– A Rare Case Top

Jammlapati Lakshmi Prameela Rani

Introduction: Cervical cancer is the 4th most common cancer among women. These malignancies frequently metastasize to the breast, bone, and lungs. However pericardial metastasis is unusual and associated with a poor prognosis. Case Details: This is a case report of a 49-year-old woman who was admitted with complaints of restlessness, dyspnea, pricking type of chest pain, fever with chills, and cough for two days. Six months prior to this she was diagnosed with carcinoma of the cervix stage IV and was started on conservative treatment at another medical facility. On clinical examination tachycardia, hypotension, and decreased heart sounds were noted. On further evaluation, cardiac tamponade and bilateral pleural effusion were found. Pericardiocentesis was performed, draining 700 ml of fluid, which on cytology showed the presence of poorly differentiated malignant cells. Cellblock was prepared from the residual pericardial fluid and the malignant cells were then stained by immunohistochemistry markers (CK5/6, CA-125, p63, CEA, EMA) which confirmed their squamous origin. No clinical improvement was seen, but the patient was discharged against medical advice and instructed for palliative chemotherapy, but she expired 15 days after the discharge. Discussion: Squamous cell carcinoma of the cervix spreads less commonly through blood vessels. Hematogenous dissemination to the heart and pericardium is generally seen in stage IV tumors. Pericardial effusion secondary to pericardial metastasis is an unusual manifestation, conferring a poor prognosis. Conclusion: Pericardial effusion is a life-threatening metastatic complication of squamous cell carcinoma which requires immediate intervention.

 Reed-Sternberg cells More Details in Pleural Effusion">   PP-101: Reed-Sternberg Cells in Pleural Effusion Top

Tanvi Paul, Meeta Singh, Manisha Ahuja, Shramana Mandal, Puneet Kaur; Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India

Introduction: Pleural effusion can be seen in up to 20-30% of patients with Hodgkin's lymphoma. However detection of Reed Sternberg cells in pleural fluid is extremely rare. Case Report: A 10 year old male child with biopsy proven case of Mixed cellularity of Hodgkins Lymphoma, presented with left axillary swelling and bilateral cervical lymphadenopathy, with fever and cough for one month. There was mediastinal widening with pleural effusion on chest X-Ray. Fine Needle Aspiration of lymph node and thoracocentesis were performed. Observation and Results: FNAC smears examined showed features consistent with Hodgkins lymphoma (CD30 and CD15 positive on immunocytochemistry). The smears prepared from thoracocentesis fluid revealed predominantly reactive mesothelial cells with eosinophils and mature lymphocytes. Occasional cells consistent with morphology of Reed Sternberg cells were identified. Conclusion: Present case is a rare interesting example of Reed Sternberg cells in effusion fluid cytology.

   PP-102: Risk of High-Grade Malignancy in the Paris System for Reporting Urine Cytology Highlights Role of Cytology in Urinary Bladder Malignancies Top

Kartik Jain, Sudeep Khera, Poonam A. Elhence, Vikarn Vishwajeet, Gautam Ram Choudhary; AIIMS, Jodhpur, Rajasthan, India

Introduction: Cancers of the urinary bladder affect more than half a million people around the world every year. The Paris System for Reporting Urinary Cytology published in 2016 provides an objectively structured non-invasive screening tool to diagnose and screen patients of urinary bladder tumours.[1] The 2022 update of The Paris system has introduced the term Risk of high-grade malignancy (ROHM) for different categories.[2] In this prospective study we assessed the diagnostic parameters and calculated risk of high-grade malignancy (ROHM) for The Paris System to detect high-grade urothelial carcinomas in samples from the urinary tract. Materials and Methods: This study included cytology and histopathology specimens from 59 patients suspected for urinary bladder malignancy. The cytological samples collected were urine and bladder barbotage specimens received in Department of Pathology and Lab Medicine of AIIMS Jodhpur from January 2020 to November 2021. The cytological findings of the urinary samples were compared with final biopsies which are the gold standard to diagnose the bladder tumours. Results: The ROHM was calculated for each category of The Paris System. The ROHM of HGUC category on cytological examination was 100%, for AUC was 33%, for NHGUC was 0% and in cases of non-diagnostic cytology samples it was 27%. Discussion: The Risk of Malignancy (ROM) was calculated for high grade urothelial carcinoma for the different cytological categories given by The Paris System. The ROHM increased progressively from NHGUC to HGUC categories with a value of 100% for the HGUC category.

   PP-103: Role of Immunostaining in Body Fluid Cytology as an Adjunct in Diagnostic Cytopathology at Tertiary Care Center Top

Manisha Raj, J K Bhatia, Vikram Singh, Pragya Sharma, P S Mishra, S K Sharma, Reetika Devashwar; Army Hospital Research and Referral Institute, New Delhi, India

Background and Objectives: Cytological specimens obtained by minimally invasive and invasive methods, are excellent source of diagnostic material. Most common and practically feasible ancillary tool used for final diagnosis in cases of equivocal cytomorphology are Immunocytochemistry (ICC) and IHC on cell blocks. Immunostains help in determining cell lineage, to differentiate benign and malignant entities and malignant entities with overlapping morphology. We aimed to investigate role of Immunostaining (ICC and IHC) in diagnostic cytopathology in various body fluid cytology (BFC) specimens. Design: A retrospective study with 1092 BFC specimens comprising of urine, CSF, pleural, pericardial and peritoneal fluids, which were processed in our laboratory from 01 Jan 2019 to 31 Jul 2022 are included. Each case was reviewed and percentage use of immunostains was estimated. We determined immunostains usage patterns according to site, and indications for their use. Results: 401 cases out of 1092 (36.7%) BFC cases were positive for tumor, out of which, total of 580 individual immunostains were performed, with an average of 1.4 immunostains per case. 18 different immunostains were used. pan CK, P40, calretinin, WT-1, TTF-1, CD 68, p53 and PAX8 were the most commonly used. Most common indication for use of immunostains was differentiating reactive mesothelial from malignant cells in pleural and ascitic fluid. Conclusion: Immunostains are primary ancillary tool when cytomorphology is equivocal. In a particular clinical and imaging context, immunostains panel is done for final opinion. Immunostaining is very useful in differentiating reactive mesothelial cells from malignant cells. ICC and IHC are complementary to each other.

   PP-104: Squamous Cell Carcinoma of Uterine Cervix with Peritoneal Metastasis: A Rare Entity Top

Nitesh Mohan; Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India

Introduction: Carcinoma cervix is the most common gynecological malignancy in India. Squamous cell carcinoma (SCC) of uterine cervix accounts for 75% to 85% of invasive cervical cancer. It generally shows lymphatic spread to adjacent lymph nodes and hematogenous spread to liver, lungs and bone. Peritoneal metastasis of SCC cervix is a rare entity. Studies have shown higher incidence of peritoneal metastasis in adenocarcinoma than in squamous cell carcinoma. Case Report: A 60 years old post-menopausal female presented to gynaecology OPD with complaints of pain and abdominal distention for 1 week. There were no associated complaints. Past history revealed that she had undergone type II radical hysterectomy with bilateral pelvic lymph node resection, followed by radiotherapy and chemotherapy for carcinoma cervix 6 months back. On histopathology she was diagnosed as non keratinizing squamous cell carcinoma FIGO IB 1 of uterine cervix. Patient was investigated for the current complaints. She was subjected to ascitic tap for fluid cytology examination. Fluid cytology examination revealed smears positive for malignant cells and was diagnosed as peritoneal metastasis of squamous cell carcinoma of cervix. Conclusion: Squamous cell carcinoma cervix showing peritoneal metastasis is an extremely rare presentation and carries poor prognosis. Peritoneal metastasis should always be considered whenever any patient of early stage SCC cervix presents with complications of malignant ascites. Majority of the patients with recurrent and metastatic disease are given chemotherapy as only treatment option.

   PP-105: The Paris System for Reporting Urine Cytology Revisited in Indian Scenario: A Pilot Study Top

Preeti Diwaker, Karishma Ranjan, Somnath Mahapatra, Mehak Kakkar; UCMS and Guru Teg Bahadur Hospital, Delhi, India

Background: The Paris system (TPS) for reporting urine cytology is being used worldwide for reporting urine cytology. However no specific guidelines from Indian Academy of Cytologists are available for reporting urine cytology in Indian patients. Hence we planned to do this study. Materials and Methods: Retrospective and analytical study in which 3 pathologists collectively reviewed 50 urine cytology smears from 21 patients (routinely reported as per TPS) for 15 cytomorphological features to diagnose high grade urothelial carcinoma (HGUC) and concordance was assessed with histopathological diagnosis. The results of this model were compared with TPS. Results: Out of 15, the cytomorphological features which revealed positive correlation with histopathological diagnosis of HGUC included: number of atypical urothelial cells (AUCs), AUCs present singly or in clusters, high N:C ratio, hyperchromasia, nuclear membrane irregularity, irregular chromatin distribution, apoptosis, mitosis and atypical squamous cells. The sensitivity and specificity of urine cytology to diagnose HGUC using this model was found to be 100% which is slightly higher than TPS (p=0.2442). The use of cut off value of >14 AUCs showed maximum sensitivity and specificity to diagnose HGUC and was significantly higher than using cut off of >10 AUCs as per TPS (p=0.0270). Conclusion: The use of cut off value of >14 AUCs and inclusion of cytological parameters like presence of apoptosis, mitosis and atypical squamous cells which are not included in TPS may improve the pickup rate of HGUC on urine cytology. Further studies with large sample size are needed to validate our study results in Indian setting.

   PP-106: Determining the Standard for Minimum Volume of Fluid Required for Detection of Malignant Cells in Malignant Ascites Top

Bhoomika Kaushik, Arvind Kumar, Nilotpal Chowdhury, Ravihari Phulware, Rajlaxmi Mundhra, Deepak Rajput, Shalini Rajaram; Department of Pathology and Lab Medicine, AIIMS, Rishikesh, Uttarakhand, India

Background: Cytological examination is the gold standard for diagnosis of malignant cells in malignant ascites. Indian academy of cytology recommend that 20-30 ml of fluid is optimum for cytological evaluation. Methods: Total 62 clinically suspicious/proven or histopathological proven malignant ascitic fluid cases were included in our study done in AIIMS Rishikesh during 1.12.20 to 13.09.22 and volume were divided into 3 volumes 5 ml, 15 ml and 45 ml respectively. Cytocentrifuge was done for these 3 volumes and May Grunwald giemsa and pap stain were done and cell blocks were prepared from the remining fluid. All May Grunwald giemsa and pap stains were studied along with cell blocks in our study. Results: A total of 62 clinically suspicious/proven case were studied. Out of these 62 Cases chemoradiotherapy history was present in 29 cases and after receiving chemotherapy 16 cases were still malignant. Total 15 cell blocks were found positive for malignancy. For total 35 case histopathology specimen were also received. We studied that malignant cell was present 90% case in 5 ml fluid sample. In only 10% cases or in 1 case we found that malignant cell was present in 45 ml and not in 5 ml and 15 ml. Conclusion: Cytopathology is a simple and reliable technique for determining the malignant cell. In our study we found that in 90% cases 5 ml fluid was sufficient for the determination of malignant cells in ascites.

   PP-107: Fine Needle Aspiration Cytology of Urinary Bladder Mass Top

Amit Kumar Adhya; AIIMS, Bhubaneswar, Odisha, India

The cells of papillary TCC are shed in urine, and cytological examination of urine sediments is usually sufficient for making a diagnosis. FNAC of these lesions is rarely attempted, and the cytological features of primary urinary bladder TCC are not well described. A 26-year- old male presented with hematuria and pyuria of 7 months' duration. Positron Emission Tomography - Computed Tomography revealed a 13 x 11 cm bladder mass with bilateral hydroureteronephrosis. There were no visceral deposits or lymphadenopathy. Computed tomography-guided fine-needle aspiration was performed, and the cytosmears were stained with May-Grunewald-Giemsa. The smears were highly cellular and showed tumor cells arranged in large cohesive clusters, papillae and lying discretely. Papilla showed fibrovascular cores. The tumor cells were round to oval with eosinophilic granular cytoplasm and had fine chromatin and central or eccentric nuclei. Intracytoplasmic vacuoles were also noted in a few cells. Many scattered spindled to racket-shaped cells with eccentric nuclei and cytoplasmic extensions were noted. High-grade TCC may be cytologically difficult to distinguish from poorly differentiated adenocarcinoma, squamous cell carcinoma, and neuroendocrine carcinoma. Immunohistochemistry of cell blocks prepared from the FNA material may be required in these cases.

   PP-108: Isolated Hydatid Cyst in Kidney – A Diagnostic Dilemma Top

Bhartendu, Ravi Hari Phulware; AIIMS, Rishikesh, Uttarakhand, India

Hydatid disease is an important zoonotic disease caused by larval stage of the echinococcus tapeworm. Most common organ affected includes liver followed by lung, however kidney is rarely affected. A 24 years old female came to Urology OPD with complaints of left flank pain for last one and half month. On examination, soft, fluctuating and nontender swelling is identified in the left flank. Radiological findings (ultrasonography and CT urography) shows single, large, simple renal cortical cyst. Clinical and radiological findings were suggestive of simple renal cyst only. Intraop 20 ml, colorless, turbid cyst fluid was sent for cytological evaluation. On microscopy, numerous scolices with radially arranged hooklets, scattered hooklets along with macrophages, foreign body giant cells and epithelial cells seen. Although not a usual finding, yet an interesting case of hydatid renal cyst was diagnosed and affirmed on cytological evaluation of cyst fluid.

   PP-109: Tophaceous Gout – A Cytodiagnosis of Metabolic Disorder Top

Pallavi Mehra; Patna Medical College and Hospital, Patna, Bihar, India

Introduction: Gout is picturesque presentation of persistent chronic hyperuricemia resulting from errors of purine metabolism or diminished renal excretion of uric acid or outcome of conditions with extensive cell turnover. It usually manifests as acute arthritis but can also present in the form of, chronic tophaceous gout with residuum of monosodium urate crystals in joint, bones and different body tissues, including the skin and soft tissues appertaining chronic destructive polyarticular involvement in otherwise asymptomatic patients. Case Report: 48-year-old man who presented with firm and non tender nodular swelling of 2*1.5 cms in the right elbow for past 1.5 years. Patient had no systemic complaints. As radiology also suggested soft tissue swelling only no clinical diagnosis was established and patient was sent for FNAC. On FNA yielded thick chalky aspirate, which on light microscopy demonstrated abundant granular amorphous material and scattered stacks and sheaves of slender needle shaped crystals. Conclusion: FNAC is very valuable in diagnosis of a periarticular lesions and thereby confirming the nature of an associated arthritis. FNAC is an easy alternative of synovial biopsy. Presence of urate crystals in the synovial fluid remains the gold standard.

   PP-110: Trichilemmal Carcinoma Arising in Proliferating Trichilemmal Cyst, Clinically Presented as Multiple Cutaneous Nodular Lesion Top

Junu Devi, Nayana Bora; Gauhati Medical College and Hospital, Guwahati, Assam, India

Background: Proliferating trichilemmal cyst, otherwise called, proliferating pilar tumor is a rare adnexal tumor found usually in areas with a high concentration of hair follicles. Malignant proliferating trichilemmal cyst is the rarest of trichilemmal tumors, having only 39 well documented cases in English literature. Case Report: A 65-year-old male presented to surgery OPD with multiple swellings all over the body involving scalp forehead, chest, anterior abdominal wall, back, bilateral upper and lower limbs for a well-established period of time. A single swelling over anterior abdominal wall was accompanied by a-non healing ulcer. The cytologic aspirate from multiple swellings revealed features of benign trichilemmal cysts, one showing features of trichilemmal cyst with calcification, hence, diagnosed as proliferating trichilemmal cyst with severe cellular atypia (? Malignant transformation) on fine needle aspiration cytology. He was advised excision and histopathological examination for confirmation. After wide local excision of the swelling the specimen was sent to our department in 10% formalin for HPE, where it was diagnosed as trichilemmal carcinoma. Conclusion: Trichilemmal cyst forms from the hair follicle and its malignant transformation is the rarest entity. Cytology gives good accuracy in determining the nature of the lesion, whether benign or malignant based on which further management decisions can be undertaken.

   PP-111: Unexpected Visitor in an Unusual Location – A Case Report Top

G Barathi; Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

Introduction: Cryptococcus is an encapsulated fungus belonging to family Tremellaceae. Although asymptomatic in immunocompetent individuals, it is the most common life-threatening opportunistic infection in immunocompromised patients. Lungs, CNS, intestines, bone marrow and retina are most commonly affected, with lymph node involvement being unusual. This is a rare case of Cryptococcal bronchopneumonia with lymphadenitis diagnosed by fine needle aspiration cytology (FNAC). Case Report: A forty two year-old HIV-positive male patient presented to the pulmonology OPD with breathlessness. He was a defaulter of antiretroviral therapy. On examination, he had multiple lymphadenopathy. A clinical diagnosis of disseminated tuberculosis was thought. CD4:CD8 lymphocyte ratio was 0.06. Radiology revealed bilateral lung nodules with a differentials of TB or Aspergillosis was made. FNAC of the cervical lymph nodes showed necrotizing inflammation with fungal organisms morphologically resembling Cryptococcus on H & E was diagnosed and the same was confirmed with special stains and India Ink preparation. Discussion: Systemic cryptococcosis occurs due to inhalation of the infectious yeast/spores. This patient was suspected to have developed bronchopneumonia secondary to tuberculosis or other opportunistic infections. In immunocompromised patients with lymphadenopathy, FNAC must be included as a first-line modality to ensure an accurate diagnosis. Conclusion: The definitive diagnosis of this case of cryptococcosis was possible only because of the simple cost-effective technique of FNAC, which prompted specific and timely treatment.

   PP-112: Urachal Papillary Adenocarcinoma Arising from the Urachal Remnants: A Rare Case Reports Top

Madhu Kumar, Preeti Agarwal, Prashant Verma, Mithilesh Chaurasia; King George's Medical University, Lucknow, Uttar Pradesh, India

Introduction: The urachus is a vestigial structure that connects the urinary bladder to the allantois during early embryonic development. Urachal adenocarcinomas are extremely rare and for accurate preoperative diagnosis needs a high degree of clinical suspicion and its correlation with the radiological findings. To increase awareness regarding this rare entity, we report a case of urachal papillary adenocarcinoma in a 67 years old female. Materials and Methods: Patient presented with ulcero-proliferative mass in the infraumbilical region for last 10 months. Her USG and CT scan of abdomen findings was an irregular heterogeneously enhancing lesion in midline of anterior abdominal wall of infraumbilical region measuring 6.0 x 5.0 x 4.5 cm, reaching up to the cutaneous plane. Fine needle aspiration cytology was advised and Biopsy specimen was also received. Results: Cytosmears revealed tumor cells arranged in clusters as well as ill formed papillae was also seen in the dirty background. FNAC of bilateral lymph nodes was free from tumor invasion. Cytomorphology was suggestive of adenocarcinoma. Biopsy sections showed malignant epithelial neoplasm arranged in papillary pattern. Individual tumor cells are pleomorphic, increased nuclear cytoplasmic ratio, vesicular nucleus with prominent nucleoli and mild to moderate amount of cytoplasm. On further evaluation with immunohistochemistry, CK7, CK20, CK34βE12, CDX2 were diffuse positive in tumor cells, Ki67 was 40% in hot spot areas and β-catenin was negative in tumor cells. Final diagnosis was urachal papillary adenocarcinoma. Conclusion: Definitive diagnosis of urachal adenocarcinoma necessitates a high degree of clinicoradiological suspicion. Immunohistochemistry plays a pivotal role in differentiating primary urachal adenocarcinoma from secondary adenocarcinomas.

   PP-113: Urinary Bladder Carcinoma Metastatic to Inguinal Lymph Node: Case Report of a Rare Metastatic Site Top

Bijayalaxmi Sahoo, Divya Aggarwal, T Balamurugan

Introduction: Urinary bladder cancer (BC) is the ninth most commonly diagnosed cancer worldwide. Involvement of lymph node in BC is common and has significant prognostic implications. The most common drainage site for BC includes the internal iliac, external iliac, obturator and presacral lymph nodes. Presentation with inguinal node enlargement is infrequent in BC. We present one such case report. Case Presentation: A 71-year-old gentleman presented to our hospital with complaint of enlarged bilateral inguinal lymph nodes for the past 3 months. The swelling was insidious in onset, and had rapidly progressed from pea sized swelling to current size of 5x4 cm over a duration of 3 months. On examination this swelling was firm to hard, 5x4 cm with overlying skin free. FNA was performed from both lymph nodes which showed features of a carcinoma with morphology suggestive of a transitional carcinoma. Further history revealed a history of frank hematuria for past 3 months. PET-CT was done to look for primary, which showed a bladder mass in posterior and left lateral wall of urinary bladder with avid perivesical, mesorectal, aortocaval, iliac and inguinal lymph nodes. A biopsy from urinary bladder confirmed the diagnosis of high grade urothelial carcinoma. Conclusion: Detailed cyto-morphological analysis on fine needle aspiration can provide helpful clues towards determination of primary, especially in aspirates from unusual metastatic sites. This case is the seventh reported case worldwide of BC metastatic to inguinal lymph nodes.

   PP-114: Utility of Fine Needle Aspiration Cytology in Diagnosing Soft Tissue Tumors and Cyto-Histopathological Correlation Top

Shilpa Bairwa; Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Nuh, Haryana, India

Background: Soft tissue tumors are defined as proliferation of nonepithelial extraskeletal tissue of the body. However diagnosis of these tumors is a challenging job because of extreme histological diversity and absence of recognizable tissue architectural patterns. Objective and Aim: Utility of fine needle aspiration cytology (FNAC) in diagnosing soft tissue tumor and to do histo-pathological correlation wherever possible. To find out sensitivity, specificity and diagnostic predictive value of FNAC in soft tissue neoplasms assuming histopathology as gold standard. Materials and Methods: It included 159 patients of all age groups, clinically presented with soft tissue swelling over a time period of 1 year. FNAC was performed. Smears were stained with H&E and MGG. The cytological details were recorded and broadly categorize according to predominant cell type and also on basis of differentiation. Results: Excisional biopsy was available in 153 cases. Accuracy of aspiration cytology in comparasion to histopathological diagnosis is 88.88%. Out of 159 cases 131 were benign, 28 were malignant by cytology. The sensitivity, specificity, positive predictive value and negative predictive value 100%, 97.36%, 89.28% and 100% respectively. Conclusion: FNAC is an excellent diagnostic modality in early diagnosis of soft tissue tumors. FNAC is highly reliable and obviates surgical procedures especially in high risk patients thus facilitating initiation of appropriate therapy and saving time and manpower.

   PP-115: Visualization of Circulating Tumor Cells in Urinary Bladder Carcinoma Top

Meriyam Jahan; AIIMS, Rishikesh, Uttarakhand, India

Background: Circulating tumor cells (CTC) are an exciting new technique which is inexpensive and fast with possible diagnostic and prognostic implicating for many cancers. Circulating tumor cells (CTCs) found in the peripheral blood and contribute greatly to metastatic process and promising target for early cancer detection, prognosis-oriented testing as well as personalized cancer therapy in urinary bladder cancer and other cancer too. Blood CTCs may also serve as a good biomarker to explore the pathways followed by the cancer cells in urinary bladder carcinoma and use in advanced urinary bladder carcinoma diagnosis. Aim: To assess the feasibility of visualizing circulating tumor cell (CTCs) in blood of suspected high grade urinary bladder cancer (HGUC). Methodology: 3 ml of blood from 10 suspected HGUC patients were collected and CTCs extracted by filtration based technique. Results: 3/10 of samples showed CTCs. Conclusion: It is feasible to visualize CTCs in a cytopathology setting for HGUC urinary bladder.

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9371.359850

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