Background : Various methods are used to arrive at a conclusive diagnosis of thyroid lesions on fine needle aspiration cytology (FNAC). Systemic pattern analysis is one such that can be used to analyze the lesions and divide them into individual categories. Aims : To study the application of pattern analysis in the interpretation of solitary thyroid nodule (STN). Materials and Methods : Two hundred and nineteen cases of fine needle aspiration cytology of STN were reviewed along with histopathological correlation. Smears were classified based on primary and secondary patterns. Predominant pattern (primary) was identified and lesion categorized. This was followed by identifying the next dominant pattern (secondary) and recategorization. Cytological diagnosis based on primary and secondary patterns was correlated with the histopathological diagnosis. Results : Based on pattern analysis, the study had a sensitivity of 66.7% and specificity of 98.9%. The positive predictive value and negative predictive value were 88.9% and 96% respectively and the overall diagnostic accuracy was 95.4%. Conclusions : The present study demonstrates the feasibility and applicability of pattern analysis in diagnosing thyroid lesions by FNAC, which could be easily reproducible.

Background : Fine needle aspiration cytology (FNAC) may be diagnostic in candidates with indeterminate solitary pulmonary nodules (SPNs) suspicious of bronchogenic carcinoma. Aims : The study was performed to evaluate the usefulness of computed tomography (CT)-guided FNAC in our centre. Materials and Methods : All the cases had a strong clinical suspicion of lung cancer, negative bronchoscopy, negative sputum cytology for malignant cells and acid fast bacilli. A thorough radiological evaluation was made to rule out primary malignancy elsewhere. Results : A total of 94 patients were studied in one year. May-Grόnwald-Giemsa stain was used for the smears. The cytological diagnosis was correlated with clinical-radiological follow-up and biopsy to arrive at a final diagnosis. The procedure had a high sensitivity and specificity. Chi-square test was used to calculate statistical significance. Tumor of more than three centimeter and immediate cytological assessment significantly increased the yield. Review of slides added two cases of malignancy that were missed initially. There were very few complications. Conclusions : CT-guided FNAC was an accurate and safe procedure for SPNs.

Background : True papillary lesions of the breast have a significantly high error rate on fine needle aspiration cytology (FNAC), as many other nonpapillary breast lesions exhibit overlapping features on cytosmears. Aim : To evaluate the utility of individual morphological features in offering a more precise cytodiagnosis in papillary lesions of the breast. Materials and Methods : Cytology smears reported as papillary lesions on nipple discharge / FNAC and histopathology over a period of two years were studied and correlated. A subjective assessment of morphological features, namely, the cellular yield, presence of three-dimensional papillary clusters, stromal bare nuclei, presence of cyst macrophages and cellular atypia was carried out on cytosmears. Results : Fourteen cases of papillary lesions were identified. Thirty-six per cent of the cases were found to be true positive, 43% false negative and 21% false positive with a sensitivity of 42% for papillary lesions. Eight of nine papillary lesions showed cyst macrophages. Stromal bare nuclei were seen in three of four malignant papillary lesions. However, the number of stromal bare nuclei was less compared to benign lesions. None of the malignant nonpapillary lesions showed stromal bare nuclei. Conclusions : Cytomorphological features alone are inadequate for the precise diagnosis of papillary lesions of the breast.

Background : Breast carcinoma is the most common malignancy globally. Cytological evaluation in breast lesions is largely subjective. Gradual progression of cells from normal to invasive involves nuclear changes that need to be viewed objectively. Aims : This study aims to apply nuclear morphometry on cytological breast aspirates. It evaluates its utility in differentiating benign vs. malignant lesions and correlates it with cytologic grading in malignant cases. Setting and Design : Nuclear morphometric parameters of malignant and benign cases were compared. Parameters of malignant cases were correlated with cytologic grading. Materials and Methods : Cytology was used to categorize aspirates from breast lumps into malignant (53 cases) and benign (29 cases). One hundred cells per case in both groups were mapped on DEBEL Cytoscan and six geometrical and three textural parameters obtained were compared. In malignant cases, morphometry was correlated with Robinson's cytologic grading, which was further correlated in tissue sections (45 cases) with modified Scarff-Bloom-Richardson histologic grading. Statistical Analysis : Students "t"-test was applied for comparison between benign and malignant cases. One-way ANOVA followed by Bonferroni's post hoc comparison was applied to compare the three cytologic grades. Results were considered significant when P<0.05. Results : Nuclear morphometry successfully differentiated between benign and malignant aspirates and correlated significantly with cytologic grades. Morphometry was especially useful in the diagnosis of atypical ductal hyperplasia and ductal carcinoma in situ. Useful parameters were mean nuclear area, long axis, short axis and total run length. Cytohistologic correlation was 83.3%, 88.9% and 88.9% for cytological grades 1, 2 and 3 respectively. Conclusions : Nuclear morphometry was thus a useful objective tool in the evaluation of breast masses.

The incidence of primary papillary carcinoma arising in thyroglossal cyst is rare and occurs in <1% of thyroglossal cysts. Even rarer is its diagnosis by pre-operative fine needle aspiration cytology (FNAC). Only 15 such cases diagnosed by FNAC have been previously reported in the literature. In this article, cytomorphology of the current case is presented along with a review of the literature on FNAC and its diagnostic pitfalls.

Pheochromocytoma is a rare tumor, accounting for <0.1% of the hypertensive population. Extra-adrenal pheochromocytomas (EAPs) are rarer still, accounting for 10% of all pheochromocytomas. Pheochromocytomas are functional catecholamine-secreting tumors of the paraganglionic chromaffin cells found in the adrenal medulla and the extra-adrenal paraganglia cells. EAPs are readily detected by computed tomography (CT) as soft tissue masses closely associated with the entire length of the abdominal aorta. Here, we present a rare case of EAP in a 45-year-old male hypertensive patient diagnosed by CT-guided fine needle aspiration cytology. The smears showed loosely cohesive tumor cells with prominent anisokaryosis and abundant eosinophilic, granular cytoplasm. The diagnosis was later confirmed by histopathology. The present case also highlights the fact that fine needle aspiration of pheochromocytoma is not necessarily contraindicated.

Sarcomatoid renal cell carcinomas of the kidney are rare neoplasms constituting about 1-5% of all renal malignant neoplasms. These are aggressive tumors and are commonly associated with conventional (clear cell) renal cell carcinomas, but cases associated with chromophobe renal cell carcinomas are sparse. Cytological features of such lesions have rarely been reported. Here, we report a unique case of a 48-year-old male patient who presented with right flank lump and pain. A fine needle aspiration was performed from the lesion under ultrasound guidance and a cytological diagnosis of pleomorphic sarcoma was made. A right-sided radical nephrectomy was carried out and subsequent histopathology revealed a sarcomatoid renal cell carcinoma with wide areas of necrosis coexisting with chromophobe renal cell carcinoma with calcification. Differentiation of pleomorphic sarcoma from a sarcomatoid renal cell carcinoma is, thus, challenging from cytopathology smears and the differential diagnoses should always be borne in mind while giving a cytopathological opinion.

A 23-year-old woman presented to our hospital with nonspecific pain in the abdomen. She underwent radiological investigations, which revealed a solid and cystic mass in the tail end of the pancreas. The mass was diagnosed to be solid pseudopapillary neoplasm of the pancreas on intraoperative scrape cytology. This was further confirmed by histopathology. The cytological diagnosis enabled appropriate surgical treatment to be planned and carried out without undue delay. It is important to distinguish this rare tumor from other pancreatic tumors with similar cytohistologic features because, if diagnosed correctly and managed surgically, this neoplasm is associated with a good prognosis.

Cutaneous leishmania life cycle images on cytology smears are very rare. We report herein a gallery of cytologic images from a case of sporadic cutaneous leishmaniasis in a 61 year old man presenting with ulcerative skin lesion.

Primary nerve sheath tumors in an intrascrotal and extratesticular location are extremely rare, with only a few cases reported in the literature. We report a fine needle aspiration cytology (FNAC)-diagnosed and histologically confirmed case of paratesticular schwannoma in a 32-year-old male. The patient had no evidence of neurofibromatosis and there was a pre-operative cytologic suspicion of leiomyoma as well. A palpable left-sided inguinal lymph node showed features of reactive lymphoid hyperplasia. This case is documented to highlight the rarity of paratesticular schwannoma and the role of FNAC in its pre-operative interpretation.