Background: The few studies on repeat aspiration focussed on accuracy of diagnosis following repeat. Numbers and documented reasons for repeat remain unaddressed. Aim: To study factors associated with requests for repeat fine needle aspiration cytology (FNAC). Settings and Design: Metropolitan hospital, clinical audit. Materials and Methods: Audit of 5104 FNAC in 10 months. Statistical Analysis Used: Univariate, and multivariate binary logistic regression. Results: Seven hundred and six patients (13.8%) were advised repeat aspirates. Three hundred and twelve of these were actually repeated (44.1%). Carryover of actually repeated aspirates to subsequent months averaged 10.8 (34.2%). Maximum numbers of repeat requests were from thyroid 76/415 (18.3%), followed by lymph node 310/1856 (16.7%), and from breast 86/716 (12.0%). Outcome of actually repeated aspirates were: Diagnostic 181/312 (58.0%), and non-diagnostic 131/312 (41.9%). Reasons for repeat were inadequate aspirates 370/706 (52.4%), non-diagnostic descriptive reports 309/706 (43.7%); in 27/706 (3.8%), no reason was mentioned. Conclusions: Inadequate aspirates, non-diagnostic descriptive reports, and FNAC/FNAB from thyroid, lymph nodes, and breast contribute to repeats. We suggest steps to reduce the number of repeat aspirates to eliminate extra work.

Background: Papanicolaou (Pap) test is an important and easy diagnostic tool to detect any abnormalities on vaginal cytology. Pap test is routinely done in women of reproductive age group in many countries. Aim: The aim of this study was to detect spectrum of abnormalities in female sex workers (FSWs) on vaginal cytology. Materials and Methods: A total of 60 cases were included over a period of 1 year (July, 2011-June, 2012). The age range of the patients was 14-61 years. Pap stained slides were evaluated by two consultant cytopathologists and reported as normal smear, inflammatory smear, specific infection, low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL), atypical squamous cell of undetermined significance (ASCUS), squamous cell carcinoma (SCC) and atypical glandular cell of undetermined significance (AGUS). Results: Most of the smears were abnormal accounting for 86.7% of total cases (52/60). Incidence of HSIL was very high in FSWs. Out of 60 cases, 8 normal smears (13.3%), 12 inflammatory smears (20%), 3 cases of infections (5%), 9 cases of LSIL (15%), 23 cases of HSIL (38.3%), 2 cases (3.3%) each of ASCUS and SCC and 1 case (1.3%) AGUS were encountered. Conclusions: Close follow-up and histologic examinations are necessary to avoid unnecessary spread of the neoplastic disease and untimely death of the patients. Awareness about diseases in FSWs and diagnostic utility of Pap test are also a must.

Background: Fiber-optic bronchoscopic biopsies yield very small bits of tissue, leading to high false negativity in lung cancer diagnosis, after paraffin embedding. Aim: The aim of the present study is to assess the diagnostic efficacy of squash smear cytology of fiber-optic bronchoscopic biopsies and to compare this with standard paraffin embedded sections and sputum cytology. Materials and Methods: A total of 100 suspected cases of lung cancer were subjected to fiber-optic bronchoscopic biopsies. Multiple biopsies from each were divided into two portions. One portion was processed routinely and paraffin sections made. Squash smears were made from the other and stained by Papanicolaou method. The diagnostic efficiency of two methods was compared. A positive diagnosis of cancer by any of the diagnostic modalities initially or during 6 months follow-up was taken as the gold standard. Results: Out of 100 cases, 91 cases proved to be cancer. The pick-up rate was 0.77 for squash cytology, 0.55 for tissue sections, and 0.31 for sputum cytology. The pick-up was higher for endo-bronchial tumors by all methods. The agreement between squash cytology and tissue sections was 100% for small cell carcinoma and adenocarcinoma and 88% for squamous cell carcinoma. Conclusion: Squash smear cytology has better pick-up rate than paraffin embedding in fiber-optic bronchoscopic biopsies and should be the preferred method when only one or few bits are available.

Background: Diagnosis of retroperitoneal lesions is one of the most difficult areas in surgical pathology. Both primary and metastatic tumors can grow silently in retroperitoneum before the appearance of clinical signs and symptoms. Guided aspiration cytology has shown a promising role in diagnosis of lesions in this region. Aims: This study was undertaken to evaluate the reliability of guided fine-needle aspiration cytology (FNAC) in the diagnosis of retroperitoneal masses and to study the spectrum of retroperitoneal lesions in a rural tertiary care hospital. Materials and Methods: This study was done on 71 patients presenting with retroperitoneal masses over a period of 20 months in a tertiary care hospital. Ultrasound-guided FNAC was done and the smears were stained by MGG and H and E stains. Histopathological corroboration could be done on all neoplastic lesions along with some non-neoplastic lesions. Results: Out of 71 cases, 48 cases (67.6%) were found to be neoplastic. Malignant tumors (35 cases) were more common than benign ones (13 cases). Malignant lesions were predominantly composed of lesions of lymph node (17 cases i.e. 48.57%) followed by sarcomas (5 cases) and germ cell tumors. Some uncommon retroperitoneal lesions like adrenal myelolipoma, renal angiomyolipoma, Burkitt's lymphoma and adrenocortical carcinoma were found in our study. Guided FNAC could diagnose all the malignant lesions with 100% accuracy except in 2 cases of poorly differentiated carcinoma which came out to be non-Hodgkin lymphoma on subsequent biopsies. Conclusion: Guided FNAC is an inexpensive, rapid and reliable method for diagnosis of retroperitoneal masses.

Background: Patients presenting with mass lesions of liver and gallbladder are a common occurrence in a cancer hospital in north central part of India. Fine-needle aspiration cytology (FNAC) serves as first line of pathological investigations, but there are pros and cons involved. Aim: The main objective of the present study was to establish adequacy of the procedure and to find out diagnostic pitfalls. An attempt was made to analyze inconclusive and inadequate aspirations. Materials and Methods: A total of 400 consecutive fine-needle aspirates of liver, belonging to 328 cases over a period of 2 years, were analyzed. Hematoxylin and eosin and May-Grόnwald-Giemsa stains were used. Chi-square test was carried out to compare significant degree of difference in different kind of diagnosis. Results: Out of 400 aspirations, 289 (72.2%) were adequate, 75 (18.7%), inconclusive and 36 (9%), inadequate. Among positive aspirations the most common was metastatic adenocarcinoma, 128 (44.2%). The positive diagnosis and adequate aspirations were significantly high (P < 0.0001). Major differential diagnostic problems were: Distinguishing the poorly differentiated hepatocellular carcinoma from the metastatic adenocarcinoma; and leukemia/lymphoma from other malignant round cell tumors. Common diagnostic pitfalls were repeated aspirations from the necrotic area and aspiration of atypical, disorganized and reactive hepatocytes, adjacent to a metastasis. No complications were observed. Conclusion: FNAC can be used successfully for the diagnosis of liver and gallbladder lesions, thus avoiding open biopsy. Study indicates the potential of using FNAC in clinical intervention where the incidence of gall-bladder and liver cancer is very high and open biopsy and surgery are not an option.

Background: Urine excreted by the body has a variable composition in different physiological and pathological conditions. The cells that come from the renal pelvis, ureters, bladder, and urethra are carried by the urine, and therefore, they can be observed in fresh samples and in smears with Giemsa and Papanicolaou stain. Aim: The aim of this study was to show that high correlation that exists between the cytological examination of fresh urine samples and smears stained with Papanicolaou and Giemsa methods. Materials and Methods: A total of 45 cases with no tumor of the urinary tract and 36 patients with lower urinary tract neoplasms were included in the study (20: Low-grade urothelial tumors; 16: High-grade urothelial tumors, squamous carcinomas, and adenocarcinomas). The sediments in the urine samples were observed in fresh specimen and in smears stained with Papanicolaou method. Results: The meticulous observation of fresh urinary sediments allowed identification of diverse cellular types associated with varied pathologies. Conclusions: The cytological examination of urinary samples in fresh smears, and its later diagnostic confirmation with the Papanicolaou stain is important not only as a diagnostic procedure of tumoral or non-tumoral pathologies, but also as a method for the 'screening' of pre-cancerous lesions or carcinoma in situ, especially in high-risk populations.

Tuberculous infection is highly prevalent in India, however, hydatid disease is relatively uncommon. Frequent sites of predilection of hydatid disease are the liver and lungs. Other unusual sites of infliction are the peritoneum, thyroid, breast, pancreas, and mediastinum. Hydatid disease in the axilla is quite uncommon. We hereby report a case of coexistent axillary hydatid disease with tuberculous lymphadenitis. To the best of our knowledge, even after extensive search of the literature we did not come across any such case. Fine needle aspiration cytology (FNAC) is a cost-effective procedure performed on an outpatient basis and helped clinch a prompt diagnosis, with minimum discomfort or complications. The role of FNAC in early diagnosis cannot be overemphasized.

Pleomorphic adenoma is the most common benign tumor of the salivary glands. They are usually composed of epithelial/myoepithelial cells and chondromyxoid stroma. Extensive lipomatous differentiation is very rare. We report a case of lipomatous pleomorphic adenoma (LPA) that presented with a mass in the hard palate of a 32-year-old woman. The fine-needle aspiration cytology material was reported as benign cytology consistent with adenoma with major adipocytic component. Histopathological examination of the excision material displayed that more than 90% of the tumor was adipocytic in texture, containing scant epithelial and myoepithelial cells and chondromyxoid stromal fragments. Preoperative cytodiagnosis of lipomatous pleomorphic adenoma on FNA is based on cytomorphology intimately associated pleomorphic adenomatous and lipomatous tissue elements. LPA should be on the mental list of the (cyto)pathologist in differential diagnosis of lipomatous tumors or non-tumorous lipomatosis or carcinoma invasion in the adipose tissue of the minor salivary gland of the hard palate.

Giant soft tissue chondromas (STCs) of the wrist are seldom encountered in clinical practice. Precise diagnosis of benign STC may pose diagnostic difficulties on clinical and radiological findings alone. We encountered a slowly growing soft tissue neoplasm in the radial aspect of the wrist joint of the right hand in a 52-year-old male, masquerading as a calcified hematoma, as suggested by magnetic resonance imaging. On cytohistopathological examination, it turned out to be a rare giant STC. The variable cellularity, in conjunction with cellular immaturity and atypia, could mislead one to a malignant pathological interpretation. Diagnosis is based on both radiological and cytohistological evaluation, which is indispensable for determining the tumor type. The detailed clinical, radiological, cytomorphological, and immune-histopathological study was carried out, which has prompted us to report this case along with a review of the literature.

Ewing's sarcoma (EWS) is an undifferentiated sarcoma of bone. Its morphologic appearance resembles many other malignant small round cell tumors. Due to the morphologic overlap, there is diagnostic difficulty and for accurate diagnosis, requires special studies such as immunohistochemistry, electron microscopy, cytogenetics, and molecular genetic analysis. We report a case of metastatic EWS from orbital mass in a 14-year-old female child diagnosed by cytology after clinicopathologic evaluation. She presented with low back ache of 1 year followed by proptosis of the right eye and swelling of the right side chest wall. Cytosmear and Tru-cut biopsy was taken from the orbital mass showed features of EWS. It was confirmed later by further studies including demonstration of EWS/friend leukemia integration-1 fusion gene by molecular genetic analysis.

Oroantral fistula (OAF) and oral candidiasis are common to come across as separate individual lesions. However when candida organisms infect maxillary sinus through OAF then diagnosis should not be limited to clinical diagnosis only. In such situation role of cytological examination can prove to be fruitful. A female with chronic long standing OAF, not responding to conventional treatment approach is reported. On incisional biopsy, the case was diagnosed as chronic maxillary sinusitis with OAF. However patient did not respond to any treatment approach and later presented with a more progressive lesion involving maxillary sinus. A cytosmear stained with periodic acid Schiff stain, revealed the presence of numerous candidal hyphae. Finally, case was diagnosed as OAF with a superadded candidal infection. Patient responded well to antifungal treatment followed by reclosure of OAF. We should not neglect a simple cytological examination which may prevent wrong diagnosis and wrong treatment.

Cutaneous metastasis from transitional cell carcinoma urinary bladder is a rare clinical entity associated with poor prognosis. This case report describes a 51-year-old male who presented with multiple cutaneous metastases arising from high grade transitional cell carcinoma bladder with lamina propria invasion. The prominent cytological features include medium sized to large pleomorphic cells with irregular nuclear outlines, coarse chromatin pattern, and tumor giant cells. An awareness of this rare clinical entity and high index of suspicion is needed for diagnosis.

A rare case of extra medullary plasmacytoma (EMP) of thyroid gland in a 60 year old male, occurring against a background of Hashimoto's thyroiditis is reported. The fine needle aspiration cytology (FNAC) initially done as an outpatient procedure, showed atypical epithelial cells on a background of amyloid. Considering these findings we gave a diagnosis of medullary carcinoma. Histology of the total thyroidectomy specimen showed an extensive infiltration of neoplastic plasma cells against a background of Hashimoto's thyroiditis, with a bizarre Hurthle cell change. Immunohistochemistry on the histology sections confirmed the diagnosis of solitary plasmacytoma of thyroid against a background of Hashimoto's thyroiditis.