Background: The diagnosis of retroperitoneal lesions is one of the most difficult areas in surgical pathology. The retroperitoneal space allows both primary and metastatic tumors to grow silently before the appearance of clinical signs and symptoms. Fine needle aspiration cytology has shown promising role in establishing the diagnosis in this region. Objectives: This study was undertaken to evaluate the reliability of ultrasonography (USG)-guided fine needle aspiration cytology (FNAC) in distinguishing between benign and malignant lesions in the retroperitoneum, and to correlate the diagnosis by cytology of retroperitoneal masses with the results obtained by histology. Materials and Methods: The study was carried out on 85 patients presenting over the last five years with retroperitoneal masses on ultrasound. Results: Out of 85 cases, 32 were of kidney, 27 of lymph nodes, 24 of retroperitoneal soft tissues, and two were of the adrenals. Malignant lesions (47) were more common than nonmalignant lesions (38). In the kidney, the maximum number of cases were of renal cell carcinoma (12-38%), followed by Wilm's tumor (6-19%), pyonephrosis (5-16%), renal cyst (4), angiomyolipoma (2), cortical pseudotumor (2), and tuberculosis (1). Out of 27 cases of retroperitoneal lymphadenopathy, 12 cases (44%) were of metastatic carcinoma followed by non-Hodgkin's lymphoma (8-30%), tuberculosis (6-22%), and Hodgkin's lymphoma (1). The two cases of the adrenals were of angiomyolipoma and metastatic carcinoma. Among the 24 soft tissue tumors in the study, seven (29%) were malignant and 17 (71%) were benign (lipoma being the most common benign neoplasm). Results from histopathological investigations were available in 47 cases, out of which 45 were consistent with the FNAC-based diagnoses. Two cases for which the histopathological results were inconsistent with the FNAC diagnoses, were of renal cell carcinoma, which had been diagnosed as renal cysts on cytology. Conclusions: USG-guided FNAC is an inexpensive, rapid, safe, and accurate procedure for the diagnosis of retroperitoneal masses.

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This study examines variation of morphologic features, including emperipolesis, during the evolution of a case of Rosai Dorfman Disease (RDD). A 44-year-old male patient with RDD affecting the salivary glands, cervical lymph nodes, nasal and maxillary sinus mucosa had a waxing and waning course over two and a half years, with episodic sudden increase in size followed by involution and then a static course with moderate sized swellings. Multiple aspirations and biopsies were performed, which form the basis of this study. Four classical cases of RDD on aspirates and another four on biopsy were analyzed for comparison, with quantification of the number of lymphocytes engulfed by histiocytes (emperipolesis). Three nasal biopsies and one salivary gland excision of the index case, performed during acute exacerbation, showed chronic inflammation and foamy histiocytes without emperipolesis, the aspirate showing emperipolesis nil in 45%, 1-3 lymphocytes in 15%, 4-10 in 36% and > 10 in 4%. Two aspirations and one lymph node biopsy done from static phase showed classical features of RDD with extensive emperipolesis, the aspirate from left cervical lymph node showing emperipolesis nil in 2%, 1-3 in 5%, 4-10 in 35% and > 10 in 58% while right cervical lymph node aspirate showed emperipolesis nil in 9%, 1-3 in 21%, 4-10 in 29% and > 10 in 41%. A biopsy performed from involuting cervical lymph node showed extensive apoptosis and vasculitis without foamy histiocytes or emperipolesis. For comparison, eight classical RDD cases showed abundant emperipolesis with mild variation. Emperipolesis is variable in RDD depending on disease activity, which has differential diagnostic relevance and demonstrates the natural history of this rare disease.

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Background: Parapharyngeal tumors are rare and often pose diagnostic difficulties due to their location and plethora of presentations. Objectives: The study was undertaken to study the occurrence in the population and to evaluate the exact nature by fine needle aspiration cytology (FNAC). Materials and Methods: A total of five hundred and six cases of lateral neck lesions were studied over three and half years. Of these 56 suspected parapharyngeal masses were selected by clinical and radiological methods. Cytopathology evaluation was done by fine needle aspiration cytology with computed tomography and ultrasonography guidance wherever necessary. Histopathology confirmation was available in all the cases. Results: On FNAC diagnosis could be established in 54 cases while in two cases the material was insufficient to establish a diagnosis. The tumors encountered were, pleomorphic adenoma (33), schwannoma (3), neurofibroma (11), paraganglioma (5), angiofibroma (1) and adenoid cystic carcinoma (1). Four false positives and two false negative cases were encountered. Overall sensitivity was 96%, with specificity of 99% and accuracy being 98.8%. Conclusions: With proper clinical and radiological assessment, FNAC can be extremely useful in diagnosing most of these lesions except a few which need histopathological and even immunohistochemical confirmation.

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There are several case reports documenting opportunistic fungal infection in the female genital tract, with Aspergillus spp being a rarely reported causative organism. We hereby report a case of Aspergillus infection in a 48 year-old, postmenopausal female with carcinoma of the cervix. She presented with features of pelvic inflammatory disease, and an initial routine cervico-vaginal smear revealed severe inflammation along with fungal bodies. The features were consistent with the presence of Aspergillus spp, while the background epithelial cells were negative for intraepithelial malignancy. She was offered therapy for pelvic inflammatory disease. A repeat Papanicolaou smear after two weeks was negative for intraepithelial organisms, but showed the evidence of a high-grade squamous intraepithelial lesion, with biopsy confirming squamous cell carcinoma.

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Nonseminomatous germ cell tumors of the testis are common and are very aggressive malignant tumors. Most of the cases have metastases at the time of diagnosis, and involvement of the posterior mediastinum in particular is well known. A 33 year-old male patient presented with complaints of a swelling on the right side of the neck that had been growing for the last month, as well as shortness of breath and cough. His thoracic computed tomography (CT) showed a 1.5 cm lymph node on the anterior mediastinum and a mass of about 11 x 10 x 8 cm extending from the right lung apex to the right hilus, with regular contours and without contrast enhancement. The patient, who was given the preliminary diagnosis of a mixture metastatic bronchial tumor plus lymphoma, was subjected to transthoracic fine needle aspiration cytology (FNAC). His abdominal CT revealed a hypodense, heterogeneous and cystic necrotic mass of about 10 x 7 x 5 cm that was para-aortic at the infrarenal level (initially predicted as a lymphoma). The patient, who could not be typed in his cytopathological examination, was diagnosed with malignant epithelial tumor and was recommended to undergo a genitourinary system examination. Upon finding a high alpha fetoprotein (AFP) value, a scrotal ultra sonography was performed which showed a mass filling the right testis. Histopathological examination of the orchiectomy material resulted in the diagnosis of mixed germ cell tumor (60% mature teratoma and 40% yolk sac tumor). Even though metastatic lesions are mostly seen in the posterior mediastinum, our findings reveal that specimens obtained with FNAC from the anterior mediastinum bear discohesive, pleomorphic, small nuclei in epithelial cells with microvacoules in the cytoplasm. These cytopathological alterations in specimens from the anterior mediastinum might promote germ cell and yolk sac tumors.

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Cutaneous metastasis is an uncommon manifestation of visceral malignancy and a grave prognostic indicator. In extremely rare cases it may be the presenting sign of underlying malignancy. Here we report two cases of carcinoma gall bladder that presented with skin nodule. Fine needle aspiration cytology of these nodules revealed metastatic deposits of adenocarcinoma and was instrumental in establishing the primaries.

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Background: Reporting templates are increasingly common in all fields of pathology. In this paper, we present an assessment of the impact of a thyroid fine needle aspiration cytology (FNAC) template on diagnostic classification and cytohistologic concordance. Materials and Methods: A thyroid FNAC reporting template was developed and introduced at a university teaching hospital. We examined FNAC reports for a five-month period before introduction of the template and compared these to the five month period after the template introduction. We recorded diagnostic categorization as well as cytohistologic correlation. Results: A total of 168 cases were identified in the five month period prior to the introduction of the reporting template and 172 cases in the five month period after the introduction of the reporting template. The template appeared to improve the diagnostic precision of benign conditions without altering the proportion of cases classified as unsatisfactory, benign or abnormal. There was no significant difference in the rate of cytohistologic concordance before and after the template introduction. Conclusions: The introduction of a reporting template for thyroid FNAC improved diagnostic precision of benign conditions and did not alter the general diagnostic classification or cytohistologic concordance.

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Gaucher's disease is the most common lysosomal storage disorder gene defect, which leads to deficiency or decreased activity of glucocerebrosidase, followed by accumulation of glucosylceramide. There is autosomal recessive transmission leading to varied clinical manifestations. This disease has three main types: Type I - nonneuronopathic; type II - acute neuronopathic; and type III - chronic neuronopathic. The nonneuronopathic type has the highest prevalence and also the greatest variability. The authors here report two cases of Gaucher's disease with uncommon presentations in early childhood, highlighting the importance of early diagnosis of the disease, as now-a-days enzyme replacement therapy may arrest further progress of disease.

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