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2012| January-March | Volume 29 | Issue 1
Online since
February 27, 2012
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ORIGINAL ARTICLES
Diagnostic utility of the cell block method versus the conventional smear study in pleural fluid cytology
Udasimath Shivakumarswamy, Surekha U Arakeri, Mahesh H Karigowdar, BR Yelikar
January-March 2012, 29(1):11-15
DOI
:10.4103/0970-9371.93210
PMID
:22438610
Background:
The cytological examinations of serous effusions have been well-accepted, and a positive diagnosis is often considered as a definitive diagnosis. It helps in staging, prognosis and management of the patients in malignancies and also gives information about various inflammatory and non-inflammatory lesions. Diagnostic problems arise in everyday practice to differentiate reactive atypical mesothelial cells and malignant cells by the routine conventional smear (CS) method.
Aims:
To compare the morphological features of the CS method with those of the cell block (CB) method and also to assess the utility and sensitivity of the CB method in the cytodiagnosis of pleural effusions.
Materials and Methods:
The study was conducted in the cytology section of the Department of Pathology. Sixty pleural fluid samples were subjected to diagnostic evaluation for over a period of 20 months. Along with the conventional smears, cell blocks were prepared by using 10% alcohol-formalin as a fixative agent. Statistical analysis with the 'z test' was performed to identify the cellularity, using the CS and CB methods. Mc. Naemer's χ
2
test was used to identify the additional yield for malignancy by the CB method.
Results:
Cellularity and additional yield for malignancy was 15% more by the CB method.
Conclusions:
The CB method provides high cellularity, better architectural patterns, morphological features and an additional yield of malignant cells, and thereby, increases the sensitivity of the cytodiagnosis when compared with the CS method.
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51
CASE REPORTS
Oncocytic lesion of parotid gland: A dilemma for cytopathologists
Indranil Chakrabarti, Amitabha Basu, Nilanjana Ghosh
January-March 2012, 29(1):80-82
DOI
:10.4103/0970-9371.93236
PMID
:22438628
Oncocytes are epithelial cells with abundant, granular, eosinophilic cytoplasm due to presence of numerous large mitochondria of varied sizes. The presence of oncocytes in salivary glands can occur in a variety of conditions. Here, we present a rare case of a 68 year old male patient who presented with a 6 cm diameter swelling in the right parotid region. A fine needle aspiration cytology done from the lesion showed a cellular oncocytic lesion. A possibility of oncocytoma was entertained. Histopathology of the mass showed a rare entity called diffuse hyperplastic oncocytosis. Originally believed to be a metaplastic process, oncocytes can occur in various lesions ranging from hyperplastic conditions to malignant neoplasms. However, diagnosis on cytological smears can be very challenging for the cytopathologist.
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ORIGINAL ARTICLES
Urothelial cells in smears from cervix uteri
Luis Alberto Palaoro, Fernando Guerra, Anabela Angeleri, Marta Palamas, Sardi-Segovia Melba, Adriana Esther Rocher
January-March 2012, 29(1):41-44
DOI
:10.4103/0970-9371.93220
PMID
:22438615
Objectives:
To establish the cytological criteria to identify the urothelial cells in cervical smears in order to avoid mistakes in the cytological diagnosis.
Materials and Methods:
Cervical smears from 34 post menopausal women with vesicovaginal fistulas, advanced bladder prolapse and genital erosive lichen planes (vulvar kraurosis) (Group 1) and transitional cell metaplasia of the cervix (TCM, Group 2) were stained with Papanicolaou technique. The cervical samples were taken during the routine annual examination for prevention of the uterine cancer.
Results:
The smears of cervix from Group 1 showed urothelial cells from the three layers of the transitional epithelium. The umbrella cells are the bigger ones with relatively large nuclei. Frequently, they are multinucleated with single or multiple nucleoli and a typical "frothy" cytoplasm (cytoplasmic vacuoles). The cells of the Group 2 showed nuclei with oval to spindled shapes, some tapered ends, less cytoplasm than squamous metaplastic cells, powdery chromatin, small nucleoli and nuclear grooves.
Conclusions:
The umbrella cells may be mistaken for dysplastic cells originating in low grade squamous intraepithelial lesions lesions (LSILs) due to their nuclear and cytoplasm sizes. Therefore, it is important to know the possibility of their appearance in the cervical smears, especially in post menopausal patients in order to avoid a false diagnosis of an intraepithelial lesion. It is unlikely that deeper cells of urothelium would be confused with high grade squamous intraepithelial lesion (HSIL) cells. However, their presence might be a reason of mistake in the diagnosis. TCM is an under-recognized metaplastic phenomenon of the cervix and vagina, which is a mimicker of high-grade squamous intraepithelial lesion. The differential characteristic between umbrella cells, cells from TCM and the deeper urothelial cells, and LSIL and HSIL are detailed in the present paper.
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Detection of abnormal cervical cytology in Papanicolaou smears
Manjit Singh Bal, Rishu Goyal, Anil Kumar Suri, Manjit Kaur Mohi
January-March 2012, 29(1):45-47
DOI
:10.4103/0970-9371.93222
PMID
:22438616
Background:
Cervical cytology by Papanicolaou (Pap) smears is an effective means of screening for cervical premalignant and malignant conditions. Cervical intra-epithelial neoplasia (CIN) and cervical cancer remain important health problems for women worldwide.
Aim:
To study the role of Pap smear in detecting premalignant and malignant lesions of cervix; and to determine the prevalence of various lesions.
Materials and Methods:
This study is based on 300 patients who attended the out-patient Department of Obstetrics and Gynaecology. Pap smears were prepared from patients presenting with complaints like vaginal discharge, post-coital bleeding, inter-menstrual bleeding, dyspareunia, and pain lower abdomen. After fixation and staining, each smear was carefully examined.
Results:
Epithelial cell abnormalities were found in 5% smears, atypical squamous cells of undetermined significance (ASCUS) in 0.3%, squamous intraepithelial lesion (SIL) in 3.4% which includes low grade squamous intraepithelial lesion (LSIL) (2.7%) and high grade squamous intraepithelial lesion (HSIL) 0.7%. Invasive carcinoma was seen in 1.3% cases. Mean age of the patients with diagnosis of LSIL was 32.3 years and for HSIL, it was 40.5 years. The mean age of the patients with invasive carcinoma was 57 years.
Conclusion:
Premalignant and malignant lesions of cervix are not uncommon in our set up and can be diagnosed early by Pap smears.
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Clinicopathological importance of Papanicolaou smears for the diagnosis of premalignant and malignant lesions of the cervix
Mulazim Hussain Bukhari, Kanwal Saba, Samina Qamar, Muhammad Muddasar Majeed, Shahida Niazi, Samina Naeem
January-March 2012, 29(1):20-25
DOI
:10.4103/0970-9371.93213
PMID
:22438612
Background:
Premalignant and malignant lesions are not uncommon in Pakistani women, especially in the older age-groups
Aim:
This study was conducted to determine the clinicopathological importance of conventional Papanicolaou (Pap) smears for the diagnosis of premalignant and malignant lesions of the cervix.
Materials and Methods:
Pap smears of 1000 women were examined from January 2007 to June 2009. Only cases with neoplastic cytology were included.
Results:
The overall frequency of normal, inadequate, neoplastic, and infective smears was 50%, 1.8%, 10.2%, and 38.3%, respectively. Most of the patients (67%) were in the postmenopausal age-group, with the mean age being 44.7±15.63 years. The commonest clinical signs/symptoms seen among the 102 patients with neoplastic gynecological lesions were vaginal discharge and abnormal bleeding (93/102;(91.2% and 62/102;60.7%). Of the 102 cases with neoplastic lesions 46 patients (45%) had low-grade squamous cell intraepithelial lesions (LSILs), 22 (21.5%) had high-grade squamous cell intraepithelial lesions (HSILs), 14 (13.7%) had squamous cell carcinoma, and 6 (5.8%) showed features of adenocarcinoma. Ten (9.8%) cases showed cytology of atypical squamous cells of undetermined significance (ASCUS) and four (3.9%) cases had atypical glandular cells of undetermined significance (AGUS).
Conclusion:
We conclude that cervical smear examination is well suited for diagnosing neoplastic disease. It is clear that cervical neoplastic lesions are becoming a problem in Pakistan.
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Cytological findings in routine voided urine samples with hematuria from a tertiary care center in south India
Sujatha Siddappa, KM Mythri, R Kowsalya
January-March 2012, 29(1):16-19
DOI
:10.4103/0970-9371.93211
PMID
:22438611
Background:
Regardless of the availability of newer and more sophisticated modalities of investigation, urinary tract cytology still remains the most commonly used non-invasive test for the diagnosis of bladder cancer.
Aims:
As hematuria is the commonest presenting symptom in patients with malignancy of urinary tract, we undertook this study to know the usefulness of urine cytology in evaluation of the hematuric patients for malignancy.
Materials and Methods:
A total of 21,557 fresh voided urine samples received at our tertiary care referral centre over a period of three years were included in the study. Of these, 1428 cases had hematuria, criteria of either gross or microscopic.
Results:
Among these hematuric cases included in the study, 32.5% (464 cases) were found to have positive finding of atypical cells. In these cases with atypia, 9.5% (136 cases) were proved to have malignancy both with the histopathological biopsy and cystoscopic findings. Other cases of atypia were found to be of reactive origin, either due to instrumentation or foreign body. A large number of hematuric cases, that is, 964 cases (67.5%) were negative for atypical cells.
Conclusions:
The limited ability of urine cytology to detect low grade bladder tumors, its subjectivity and lack of uniformity in reporting, all render urine cytology a less than perfect tool. With added collaboration between clinician and cytopathologist, urine cytology can be used an adjunct tool in evaluation of patients with hematuria.
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CASE REPORTS
Detection of lupus erythematosus cells in pleural effusion: An unusual presentation of systemic lupus erythematosus
Sushma Gulhane, Nitin Gangane
January-March 2012, 29(1):77-79
DOI
:10.4103/0970-9371.93232
PMID
:22438627
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease typically diagnosed by a combination of physical findings and clinical laboratory testing. Several decades ago, the diagnosis of lupus included the lupus erythematosus (LE) cell assay. SLE is associated with pleuropulmonary manifestations in well over 50% of cases. Although pleural effusion is common but very rarely is the initial manifestation of disease. There are very few reports of SLE diagnosed in a cytopathology laboratory. We report an unusual case of SLE in a 16-year-old female who presented with acute shortness of breath, fever and cough. Her chest radiograph showed bilateral pleural effusion. This effusion was tapped and sent to the cytopathology laboratory. The cytological examination of the pleural fluid revealed numerous LE cells and led to the diagnosis of SLE. Autoimmune serology techniques such as anti-nuclear antibody staining have replaced the LE cell assay. However, as presented in this report and found in a review of the literature, the
in vivo
finding of LE cells by cytopathology can provide an important clue to the diagnosis of SLE, especially when associated with an uncommon presentation.
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ORIGINAL ARTICLES
Cytogenetic biomonitoring in petrol station attendants: A micronucleus study
Medhini Singaraju, Sasidhar Singaraju, RN Parwani, SP Wanjari
January-March 2012, 29(1):1-5
DOI
:10.4103/0970-9371.93208
PMID
:22438608
Background:
Benzene, which is a major organic product, on chronic exposure can result in many malignant disorders, and therefore exposure to gasoline vapors is classified by the International Agency for Research of Cancer as possible carcinogenic to humans. Petrol station attendants are chronically exposed to petroleum derivatives through inhalation of petrol during vehicle refuelling.
Aim:
This study is aimed to investigate cytogenotoxic damage in exfoliated buccal cells obtained from petrol station workers and control subjects using micronucleus (MN) test.
Materials and Methods:
This study was carried out on 30 petrol station attendants working at different petrol stations located in Indore. The control group consisted of 30 healthy subjects who were not exposed to benzene. Buccal cell samples were collected at the end of the work shift. Slides were stained and were evaluated to determine the MN frequencies. Exposure monitoring was performed by the detection of phenol excreted in the urine. Urinary phenol measurements were performed following the colorimetric quantitative determination method of Yamaguchi and Hayashi.
Results:
Variations in MN frequencies were seen in control and petrol bunk attendants.
Conclusion:
The MN test in exfoliated epithelial cells seems to be a useful biomarker of occupational exposure to genotoxic chemicals. Phenol is the principal metabolite of benzene. Therefore, phenol concentration in the urine of exposed workers can be used as a biomarker of external exposure.
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Fine needle aspiration cytology of ovarian tumors with histological correlation
Anjali Bandyopadhyay, Jayati Chakraborty, Anadi Roy Chowdhury, Aditi Bhattacharya, Palas Bhattachrya, MK Chowdhury
January-March 2012, 29(1):35-40
DOI
:10.4103/0970-9371.93218
PMID
:22470227
Background:
Till today, there has been some hesitation to accept the role of fine needle aspiration cytology (FNAC) in pelvic mass. We have tried to study the role of ultrasonography (USG) and computed tomography (CT) guided FNAC as diagnostic and supportive investigation for ovarian tumors.
Aim:
To evaluate the current status of image-directed percutaneous aspiration of ovarian neoplasm for the purpose of early detection of malignancy.
Materials and Methods:
Seventy-four fine needle aspirations of ovarian neoplasms were performed between January 2007 and December 2008 by transabdominal approach under USG and CT guidance and correlated with histopathological findings and tumor markers.
Results:
A total of 47 (63.5%) cases were assessed as malignant and 21 (28.3%) as benign and 6 (8.1%) as inconclusive. The neoplastic lesions were categorized as per World Health Organization (WHO) classification.
Conclusion:
With the availability of modern techniques, USG and CT guided FNAC can be an optimum modality for the diagnosis of primary and metastatic ovarian neoplasms and evaluation of recurrent malignant tumors, which has great impact on patient management consequently.
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CASE REPORTS
Cytological diagnosis of tuberculous cervicitis: A case report with review of literature
R Kalyani, SR Sheela, M Rajini
January-March 2012, 29(1):86-88
DOI
:10.4103/0970-9371.93242
PMID
:22438630
Tuberculosis of cervix is a rare disease. Tuberculosis usually affects women of childbearing age, indicating hormone dependence of infection. The patient presents with menstrual irregularities, infertility or vaginal discharge. Cervical lesions presents as papillary/vegetative growth or ulceration mimicking cervical cancer. Cervical Papanicolaou (Pap) smear plays an important role in diagnosing the disease by non-invasive technique in which the presence of epithelioid cells and Langhan's type of giant cells is diagnostic. However, other causes of granulomatous cervicitis should be considered and ruled out. Ziehl-Neelsen (ZN) stain for acid fast bacilli, fluorescent technique, biopsy and culture help in confirming the disease. We present the case of a 45-year-old female, who presented with vaginal discharge, dysfunctional uterine bleeding, first degree uterine descent with grade II cystocele and rectocele and cervical ulcer. Pap smear revealed epithelioid cells and Langhan's type of giant cells, confirmed by ZN stain of cervical smear, fluorescent technique and culture.
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ORIGINAL ARTICLES
Evaluation of precision of guidance techniques in image guided fine needle aspiration cytology of thoracic mass lesions
Shivani Kalhan, Pankaj Sharma, Sonia Sharma, Sharmila Dudani, TS Ramakrishnan, Anupama Chowdhry
January-March 2012, 29(1):6-10
DOI
:10.4103/0970-9371.93209
PMID
:22438609
Background:
Transthoracic fine needle aspiration cytology (FNAC) is an established and safe technique for diagnosis of thoracic mass lesions. Computed tomography (CT) scan depicts clear anatomical details and provides access to any area of the body. It is, however, expensive and the needle is not passed in real time. Ultrasound is cheaper, radiation free, and allows real time monitoring. Its limitations are obscurement of lesions by aerated lung, smaller, deep seated, and cavitary lesions.
Aims:
This study aims to compare sensitivity and specificity of CT scan and ultrasonography (USG) in thoracic FNAC.
Materials and Methods:
The study was conducted on patients who presented with thoracic mass lesions in lungs, mediastinum, hilar lymph nodes, thoracic vertebrae, paraspinal soft tissue, and pleura. One hundred and twenty patients were studied. Only those cases in which sonographic guidance was not possible were taken up for CT guided FNAC. The lesions were assigned to benign and malignant categories and into specific diagnoses where possible. Biopsy correlation was available in 113 cases. Patients were lost to follow-up in five lung and two mediastinal masses.
Statistical Analysis:
Statistical tests applied included diagnostic tests for sensitivity and specificity.
Results:
An accuracy of 70.8% was found for image guided FNACs with a sensitivity and specificity of 92.2% and 100%, respectively. CT had a sensitivity of 93.2% and specificity of 100%. For USG guidance, the same was 91.3% and 100%, respectively.
Conclusions:
Precision of USG and CT scan is comparable for guidance in FNAC from thoracic mass lesions.
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CASE REPORTS
Eggs containing larvae of
Enterobius vermicularis
in vaginal smear
Jyothi B Shetty, Dhanashri V Kulkarni, VL Prabhu
January-March 2012, 29(1):94-96
DOI
:10.4103/0970-9371.93238
PMID
:22438633
Enterobius vermicularis
also known commonly as pinworm is the most common intestinal parasite. It is a nematode that inhabits the human terminal ileum, colon and appendix. The fertilized female migrates to the perianal area where eggs are deposited but occasionally introduces itself into adjacent orifices, most commonly the female genitourinary tract. Thus the eggs can be seen in the vaginal smear as a result of contamination. We report a case wherein the patient presented with signs and symptoms of vulvovaginitis. In her vaginal smear there were eggs of
Enterobius vermicularis
which showed a coiled larva within it. In the background there were plenty of acute inflammatory cells. This patient responded favorably to antihelminthics. We report this case to highlight the morphology of the parasite and also to emphasize that such findings should not be neglected. Timely reporting and appropriate treatment of such cases will prevent further complications of this parasite including endometritis, salphingitis and peritonitis.
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Poorly differentiated (insular) thyroid carcinoma arising in a long-standing colloid goitre: A cytological dilemma
Hema Kini, M Nirupama, Aarathi R Rau, Sumit Gupta, Alfred Augustine
January-March 2012, 29(1):97-99
DOI
:10.4103/0970-9371.93237
PMID
:22438634
Poorly differentiated (insular) thyroid carcinoma (PDITC) is an uncommon thyroglobulin producing neoplasm intermediate in aggressiveness between well-differentiated carcinomas of follicular cell origin and undifferentiated anaplastic carcinoma. Its cytomorphological recognition is essential for planning surgery and subsequent management as it is known for its aggressive behavior, advanced stage at presentation, local recurrences and rapid dissemination. We report a case of PDITC arising in a long-standing goiter, in which presence of microfollicular structures and minimal necrosis resulted in difficulty in distinguishing it from a follicular neoplasm of thyroid.
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Aggressive giant cell tumor of the anterior arc of the rib
HK Manjunatha, AS Ramaswamy, B Sunil Kumar
January-March 2012, 29(1):51-53
DOI
:10.4103/0970-9371.93224
PMID
:22438618
Giant cell tumor of bone also known as osteoclastoma is a distinct clinical, roentgenographic and pathologic entity with specific characteristics. It is a benign but locally aggressive neoplasm, classically seen as a purely lytic lesion of the epiphyseal or metaphyseal-epiphyseal region of long tubular bones extending to the articular surface. It usually occurs after skeletal maturation and is one of the rare bone tumors that more frequently affects women. Even though rarely it can occur in ribs, it usually occurs in the posterior aspect. We report here a case of giant cell tumor originating from the anterior arc of the rib diagnosed on fine needle aspiration cytology.
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Sebaceous carcinoma of the eyelid diagnosed on fine needle aspiration cytology
Meenu Gill, Shilpa Garg, Rajnish Kalra, Rajeev Sen
January-March 2012, 29(1):75-76
DOI
:10.4103/0970-9371.93231
PMID
:22438626
Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which has aggressive local behavior and can metastasize to regional lymph nodes and distant organs. It is a malignant neoplasm known to masquerade as other benign and less malignant lesions, resulting in delay in diagnosis and relatively high morbidity and mortality. Aspiration cytological features of this neoplasm have not been well characterized in the literature. We report a case of this tumor diagnosed on fine needle aspiration. Clinically, a diagnosis of chalazion was made and fine needle aspiration cytology (FNAC) was performed. Cytological diagnosis of a malignant tumor with closest resemblance to sebaceous carcinoma was suggested which was confirmed on histopathology. Eyelid reconstruction was done after histopathological confirmation of tumor-free margins. The article highlights the role of FNAC in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma to prevent recurrence and metastasis.
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Fine needle aspiration cytology in fibromatosis
Pranay Tanwar, Nalini Gupta, Rakesh Kumar Vasishta, Gurpreet Singh
January-March 2012, 29(1):66-68
DOI
:10.4103/0970-9371.93221
PMID
:22438623
Fibromatosis form a spectrum of clinicopathologic entities characterized by the infiltrative proliferation of fibroblasts that lack malignant cytologic features. The fibromatosis can be localized or infiltrative and multicentric and can involve internal tissues and organs as the mesentery, retroperitoneum, breast, and almost every organ and region of the body, including the bones, the meninges and the central nervous system. We report a case of 37-year-old male who presented with a right supraclavicular mass with superficial infiltrative type of fibromatosis and fine needle aspiration cytology (FNAC) was performed. We report this case because of limited literature of FNAC in fibromatosis and quick role of FNAC in the diagnosis of fibromatosis.
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Hemangioendothelioma of soft tissue: Cytological dilemma in two cases at unusual sites
Sumana Mukherjee, Jayati Mallick, Prabir C Pal, Sarbani Chattopadhyay
January-March 2012, 29(1):89-91
DOI
:10.4103/0970-9371.93241
PMID
:22438631
Hemangioendothelioma is a rare vascular tumor of intermediate malignancy. Cytologically, it can simulate a non-vascular malignant tumor. We report two cases of this tumor, which were misdiagnosed at cytology. In the first case, a 27-year-old man presented with an anterior abdominal wall tumor. Fine needle aspiration cytology (FNAC) of the tumor showed polygonal cells with vacuolated cytoplasm in clusters having moderate nuclear atypia in a background of necrosis. A diagnosis of metastatic carcinoma was made. The histological examination showed features of epithelioid hemangioendothelioma. In the second case, a 13-year-old female child presented with unilateral enlargement of the right tonsil. At ultrasound-guided FNAC, a diagnosis of, 'small round cell tumor, could be consistent with alveolar rhabdomyosarcoma,' was made. The histological examination showed features of papillary intralymphatic angioendothelioma (Dabska's tumor). We conclude that epithelioid hemangioendothelioma should be considered in the differential diagnosis of metastatic carcinoma and small round cell tumor even at unusual sites.
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Multicentric synchronous recurrent aggressive fibromatosis
Kavita Kohli, Vibha Kawatra, Nita Khurana, Shyama Jain
January-March 2012, 29(1):57-59
DOI
:10.4103/0970-9371.93227
PMID
:22438620
Extra-abdominal desmoid tumors are known as aggressive fibromatosis (AFM). Synchronous and metachronous multicentric aggressive fibromatosis are rare lesions and pose dilemma in diagnosis and management. A rare and interesting case of recurrent multicentric, synchronous AFM is presented which to the best of our knowledge has not been reported earlier. A young male presented with well defined, hard, fixed swelling on the thigh. Resected tumor mass on histopathology was diagnosed as an extra abdominal fibromatosis. He presented again after two months with swelling at the same site; and two more swellings on the foot. Fine needle aspiration cytology (FNAC) from all three sites was performed; and was suggestive of benign spindle cell lesion of fibrogenic origin with the possibility of multicentric synchronous recurrent aggressive fibromatosis.
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ORIGINAL ARTICLES
Study of computed tomography-guided fine needle aspiration cytology of thoracic lesions
Maggad Rangaswamy, Togy Thomas Zacharia, Jayashree Krishnamurthy, Gururajprasad Chennakeshaviah, Sunila , Manjunath Gubbanna Vimala
January-March 2012, 29(1):30-34
DOI
:10.4103/0970-9371.93217
PMID
:22438614
Background:
Thoracic lesions include a variety of benign and malignant lesions of lung, pleura, chest wall and mediastinum. Transthoracic fine needle aspiration cytology (TFNAC) is a well established technique for work up of thoracic lesions. Computed tomography (CT) has extended the use of FNAC, because it is accurate for localization, needle puncture and above all it permits evaluation of lesions less than 1 cm. This diagnostic modality has a high sensitivity, specificity and is of relatively low cost.
Aims:
To assess the role of CT-guided FNAC in the diagnosis of thoracic lesions.
Materials and Methods:
Eighty three patients with various thoracic lesions were evaluated by CT guided FNAC. The cytologic findings were compared with cell blocks whenever available.
Results:
Conclusive opinion was offered on cytology smears in 80 patients. Lesions of the lung were the most common. Neoplastic lesions in our study accounted for 65% of cases. The sensitivity and specificity of the study were 93.33% and 100%, respectively.
Conclusion:
CT-guided TFNAC is a low cost, safe, minimally invasive and accurate diagnostic procedure with high sensitivity and specificity and when interpreted in conjunction with clinical and radiological data can prevent some of the pitfalls in diagnosis.
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Clinicopathologic study of parapharyngeal tumors
Mimi Gangopadhyay, Arghya Bandopadhyay, Swapan Sinha, Subrato Chakroborty
January-March 2012, 29(1):26-29
DOI
:10.4103/0970-9371.93216
PMID
:22438613
Background:
Parapharyngeal space (PPS) tumors are rare. Three main groups are identified, namely those of salivary origin, neurogenic tumors and paragangliomas. Early pathological classification of PPS tumors is important for pin point diagnosis and timely management.
Aims:
The PPS is a complex anatomical potential space and poses high risk of per and postoperative complication. This study was done to perform optimum preoperative evaluation by clinicoradiologic correlation and guided fine needle aspiration cytology (FNAC) which is essential to minimize intraoperative risk.
Materials and Methods:
Guided FNAC was carried out to diagnose parapharyngeal tumors in 48 patients from January 2008 to January 2010. The inflammatory lesions were excluded in the present study. Correlation with histopathology was done in all the cases.
Results:
The mean age for all the patients was 38.2 years. There were 23 male and 25 female subjects. Seventy nine percent of the lesions were benign with pleomorphic salivary adenoma being the commonest, while only 20.8% of the lesions were malignant. All the patients presented with neck swelling. No complication was encountered in the present study.
Conclusion:
FNAC can replace incisional biopsy which may be hazardous in this area. Immediate treatment can be planned based on the FNAC report.
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CASE REPORTS
Mucinous carcinoma of the male breast with axillary lymph node metastasis: Report of a case based on fine needle aspiration cytology
Anjali P Ingle, Anjali S Kulkarni, Sunita P Patil, Neela R Kumbhakarna, Rajan S Bindu
January-March 2012, 29(1):72-74
DOI
:10.4103/0970-9371.93228
PMID
:22438625
Pure mucinous carcinoma of the male breast is an uncommon malignant breast neoplasm and extremely rare is its metastasis in axillary lymph nodes. Most of these cases have been diagnosed after surgical resection with only a few cases diagnosed on fine needle aspiration cytology (FNAC). Although FNAC is well established in the evaluation of breast masses in females there are few reports in males. We are presenting a case of pure mucinous carcinoma of the male breast with metastasis in axillary lymph nodes in a 75-year-old male diagnosed by FNAC and confirmed on histopathology.
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3
Cytodiagnosis of secretory carcinoma of the breast
Vissa Shanthi, Baddukonda Appala Rama Krishna, Nandam Mohan Rao, Ciddarla Sujatha
January-March 2012, 29(1):63-65
DOI
:10.4103/0970-9371.93214
PMID
:22438622
Secretory carcinoma is a rare form of breast carcinoma which has a predilection for juveniles and young adults (usually less than 30 years of age), becoming progressively less common with advancing age. It is a low grade breast carcinoma which shows distinct features at histology. Diagnosis of this carcinoma on fine needle aspiration cytology (FNAC) is difficult. We report a case of a 62-year-old woman diagnosed to have secretory carcinoma of breast on FNAC. Histopathological examination confirmed the diagnosis. The recognition of secretory carcinoma is important because the cytological findings can be confused with those of lactating breast. Preoperative diagnosis is essential for appropriate surgical therapy. Secretory carcinoma is reported to have good prognosis, but surgical therapy with an axillary node dissection is recommended, since axillary metastases have been found in approximately 30% of the recorded cases.
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2
Granular cell tumor in inguinal region: A case of mistaken identity on cytology
Shalinee Rao, S Rajendiran, P Surendran, PM Venkata Sai, D Prathiba
January-March 2012, 29(1):60-62
DOI
:10.4103/0970-9371.93229
PMID
:22438621
A 63-year-old male presented with sudden increase in size of a right inguinal swelling which was present for the past 10 years. Clinical diagnosis of inguinal soft tissue mass/lymph node enlargement was made and patient was investigated further for a conclusive diagnosis. Ultrasound examination suggested it to be a lymph node and guided fine needle aspiration cytology was performed. Cytology was suggestive of a reactive lymph node. Subsequently, an excision biopsy was performed that revealed a granular cell tumor with many lymphoid aggregates. On reviewing the cytosmears, we realised that the granular neoplastic cells were mistaken for histiocytes; and the lymphoid background and bare nuclei mislead us to consider it a reactive lymph node. Since granular cell tumor can occur almost anywhere, a careful examination of cytosmears and knowledge of its distinctive cyto-morphological features would be helpful in providing an accurate diagnosis on cytology.
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2
Oncocytic carcinoma of lip: A rare neoplasm of minor salivary gland
Sonia Chhabra, Sunita Singh, Divya Sethi, Qury Sabita Mahapatra
January-March 2012, 29(1):69-71
DOI
:10.4103/0970-9371.93225
PMID
:22438624
Oncocytic carcinoma is an extremely rare neoplasm of the salivary gland, with only a few cases reported in literature till date. We report the occurrence of this rare lesion in lip in a 43-year-old female presenting with a progressively increasing swelling for which excision was done. Fine needle aspiration was done and the smears revealed tumor cells with well-defined cell borders, round to oval, central to eccentrically located moderately pleomorphic nuclei with fine chromatin, prominent nucleoli and abundant eosinophilic granular cytoplasm. Microscopic examination of the resected tumor showed solid sheets, nests, islands and cords of oncocytic cells diffusely infiltrating the surrounding tissues. After 5 months, the patient again presented with bilateral submandibular and right axillary lymphadenopathy revealing metastatic deposits from oncocytic carcinoma. We report this case of oncocytic carcinoma because of its unusual location, the minor salivary gland of lip being a rare site for the tumor.
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1
Isolated intrathyroidal metastasis revealing an occult lung adenocarcinoma
Sunil Pasricha, Jatin S Gandhi, Anurag Mehta, Gurudutt Gupta
January-March 2012, 29(1):92-93
DOI
:10.4103/0970-9371.93240
PMID
:22438632
Thyroid gland is an uncommon site of tumor metastasis inspite of rich vascular supply. Most of the cases are picked up after the diagnosis or during the work up for the primary. Unexpected involvement of thyroid gland as the first presenting sign in a primary lung adenocarcinoma is an extremely rare, however, clinically significant finding, upstaging the disease. Fine needle aspiration cytology as a primary tool for detecting metastasis in thyroid is a rapid procedure, associated with high accuracy and low morbidity.
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Fine needle aspiration cytology of unilesional mycosis fungoides d'emblee
K Amita, S Vijay Shankar, Abinash Hazarika, AN Roopa
January-March 2012, 29(1):54-56
DOI
:10.4103/0970-9371.93226
PMID
:22438619
Primary cutaneous T-cell lymphoma is a rare lymphoproliferative disorder accounting for 2% of all lymphomas. Mycosis fungoides (MF) is a rare, albeit commonest form of primary cutaneous T cell lymphoma. MF d'emblee is an uncommon variant which is easily mistaken clinically for epithelial malignancy. Diagnosis at cytology is challenging due to low degree of suspicion, rare occurrence and diverse morphology. We report a case of 51-year-old male presenting with a solitary nodulo-ulcerative lesion over right thigh. Smear showed atypical lymphocytes with hyper-convoluted cerebriform nuclei along with few mature lymphocytes consistent with MF. To our knowledge, this is the first report of unilesional MF d'emblee diagnosed at fine needle aspiration cytology (FNAC). Our case emphasizes that FNAC is an accurate method for early diagnosis and clinical staging of patients with MF.
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Fine needle aspiration diagnosis of Rosai-Dorfman Disease involving thyroid
Sudhir Kumar Vujhini, Sachin S Kolte, Rahul N Satarkar, Shastry Srikanth
January-March 2012, 29(1):83-85
DOI
:10.4103/0970-9371.93239
PMID
:22438629
Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy is a rare disease involving the lymph nodes. Extranodal RDD involving the thyroid is extremely rare. So far, six cases of RDD involving thyroid have been reported in the literature; all have occurred in females with a mean age of 56.3 years. Clinically, radiologically and cytologically, all the cases were initially diagnosed as thyroid malignancies with lymph nodal metastasis. The final diagnosis was made histologically only after total thyroidectomy. We herein, present a seventh case of RDD involving the thyroid in a 15-year-old female, diagnosed first on fine needle aspiration cytology (FNAC). We conclude that FNAC is a useful diagnostic procedure for RDD involving thyroid; it can avoid an unnecessary thyroidectomy.
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9
IMAGES IN CYTOPATHOLOGY
Cytomorphological spectrum of hydatidosis with eosinophilia, clinically mimicking a malignancy: An uncommon presentation
Bharat Rekhi
January-March 2012, 29(1):48-50
DOI
:10.4103/0970-9371.93223
PMID
:22438617
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2,931
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LETTER TO EDITOR
Response to "CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma"
PRK Bhargav
January-March 2012, 29(1):100-100
DOI
:10.4103/0970-9371.93234
PMID
:22438635
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2,398
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© <%=year(date())%> Journal of Cytology |
Indian Academy of Cytologists
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Online since 15
th
April, 2008