Background: One of the constraints of the conventional FNA smear is the limited material available for adjuvant diagnostic investigations including immunocytochemistry. The cell block technique employs the retrieval of small tissue fragments from a FNA specimen which are processed to form a paraffin block. It is widely accepted that cell block technique increases the cellular yield and improves diagnostic accuracy. The ability to obtain numerous tissue sections allows for multiple immunostains and other studies to be performed akin to paraffin sections produced in histopathology. Aims: To determine the effectiveness of the cell block technique by comparing cytomorphological preservation and immunocytochemistry (ICC) stains on paired cell block and conventional fine needle aspiration (FNA) samples. Materials and Methods: In this prospective study, material for both glass slides and cell blocks were collected simultaneously during fine needle aspirates from 47 samples comprising lung and liver masses. Grading of cellularity, morphological preservation, architectural preservation, immunocytochemical staining intensity and presence of background staining on paired FNA smears and cell block samples were compared. Each arm of the paired analysis was performed blindly without knowledge of the grading outcome of the other. The Kappa statistic (κ) was used to measure inter-rater agreement. Results: The 47 samples evaluated included FNAs from the lung, 24/47 (51%) and liver, 23/47 (49%). The immunocytochemistry stains consisted of 44/47 (94%) CK7; 44/47 (94%) CK20; 18/47 (38%) TTF1; 10/47 (21%) synaptophysin; 10/47 (21%) Hepar-1 and 7/47 (15%) AE1/3. There was no overall agreement in preservation of cytomorphological detail and ICC staining between the two methods. The Papanicolaou-stained conventional FNA smears fared better than the cell block for the evaluation of nuclear and morphologic characteristics. The ICC stains worked better on the cell block samples due to lack of background and aberrant staining. Conclusion: Direct FNA smears and cell blocks complement each other and our results indicate that both are needed in the diagnostic work-up of patients. The cost implications of performing both techniques on all FNA material warrants further evaluation.

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Cryptococcosis is a common opportunistic infection among immunocompromised individuals. Some of the commonly affected sites are respiratory and central nervous system. Lymph node is an unusual site of involvement which could mimic tuberculosis, as seen in our case. We report a 32-year-old male immunocompromised patient presenting with generalized lymphadenopathy who was clinically suspected to have tuberculous lymphadenitis. He was diagnosed to have disseminated cryptococcosis on fine needle aspiration cytology and fungal isolation on culture.

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Sinonasal malignant melanoma is of unusual occurrence. Common sites for melanomas are head, neck region, and the lower extremities as they are exposed to sunlight, which is one of the predisposing factors. We report a case of primary mucosal malignant melanoma of the nasal cavity in a 68-year-old male for its rare occurrence. The primary knowledge of its existence and evaluation of its cytological features are important for a correct preoperative cytological diagnosis and thereby clinical implications for appropriate therapeutic intervention. The cytological features when evaluated along with clinical, histopathological and immunohistochemical features are sufficiently diagnostic. The rarity of its occurrence warrants its mention.

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Germ cell tumors of ovary with elements of two or more subtypes are relatively uncommon. Sarcoid-like granulomas are seen in rare association with dysgerminomas, a subgroup of germ cell tumors of ovary, which are again less common. Fine-needle aspiration cytology (FNAC) of the gonadal germ cell tumor, though not performed frequently, is of help when a gonadal mass does not require resection as in lymphoma which can be treated by chemotherapy. FNAC helps to diagnose this tumor and to rule out other lesions, including germ cell tumors. It is also an effective, rapid and reliable procedure for the diagnosis of germ cell tumors.

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Background: Immunocytochemistry (ICC) is an established routine diagnostic adjunct to cytology and histology for tumor diagnosis but has received little attention for diagnosis of tuberculosis. Aims: To have an objective method of direct visualization of mycobacteria or their products in clinical extrapulmonary tuberculosis (EPTB) specimens, immunocytochemical localization of M. tuberculosis antigen by staining with species specific monoclonal antibody to 38-kDa antigen of Mycobacterium tuberculosis complex. Materials and Methods: Immunostaining with specific monoclonal antibody to 38-kDa antigen of Mycobacterium tuberculosis complex was done in fresh and archival fine needle aspirates and tissue granulomata of 302 cases of extrapulmonary tuberculosis and was compared with the molecular diagnostic i.e., nucleic amplification and conventional [Cytomorphology, Ziehl Neelsen (ZN) staining and culture] tests and 386 controls. Results: Diagnostic indices by Bayesian analysis for all types of archival and fresh material varied from 64 to 76% in nucleic acid amplification (NAA) and 96 to 98% in ICC. There was no significant difference in the diagnostic indices of ZN staining and/ or ICC in fresh or archival material whereas the sensitivity of NAA differed significantly in fresh versus archival material both in cytology (71.4% vs 52.1%) and histology (51.1% vs 38.8%). ICC can be easily used on archival smears and formalin-fixed paraffin-embedded tissue sections with almost equal sensitivity and specificity as with fresh material, in contrast to NAA which showed significant difference in test results on archival and fresh material. Conclusions: Low detection sensitivity of MTB DNA in archival material from known tuberculous cases showed the limitation of in-house NAA-based molecular diagnosis. ICC was found to be sensitive, specific and a better technique than NAA and can be used as an adjunct to conventional morphology and ZN staining for the diagnosis of EPTB in tissue granulomas.

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We report a case of primary actinomycosis of breast diagnosed by fine needle aspiration cytology (FNAC) in a postmenopausal lady who presented with a clinical impression of malignancy. Resolution of infection while conserving the breast was achieved by timely diagnosis and effective antibiotic therapy. The literature reports that primary actinomycosis of the breast is very rare after menopause, with only very few cases found after extensive search. It is imperative that this condition should be considered in the differential diagnosis of malignancy. The effectiveness of cell block sections in the final diagnosis is also highlighted.

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Background: Epidermal inclusion cyst in the breast (EICB) is very rare. It presents as breast lump mainly in peri-areolar region and needs to be differentiated from other breast lesions with predominance of squamous cells. Aim: To analyze the role of fine needle aspiration cytology (FNAC) in patients presenting with breast lump. Materials and Methods: The present study is a retrospective study over the period of past 2 years, where the patients presented with firm breast lumps. Six of these cases were diagnosed as EICB on FNAC. Smears from these cases were reviewed for cytomorphological findings and correlated with clinico-radiological details. Results: Patients ranged in age from 25 to 60 years, and female to male sex ratio was 2:1 (female 4, male 2). Mammography was done in women (4), which showed solid, well-defined mass lesions in peri-areolar region and were suggestive of benign breast lesions (3) and infective lesion (1). FNA was performed; Giemsa-stained smears showed predominantly mature benign squamous cell and anucleated squames in all cases, thus one of the cytological diagnoses was EICB. Five of these cases had histological confirmation. Conclusion: EIC of breast is not that rare lesion as considered. The patients may not seek medical attention because of small painless swelling; unless the lump increases in size or becomes painful. FNAC is confirmatory in the presence of a typical pultaceous aspirate and cytomorphological features of EIC. Thus, FNAC plays a crucial role in its diagnosis and management. Symptomatic cases should be readily excised and need histological correlation to rule out any potential complications that can arise in these cysts.

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Malignant lymphoma that secondarily involves the cervix is a rare condition and may be difficult to distinguish from follicular cervicitis and small cell carcinoma. Cervical lymphoma is sometimes misdiagnosed on cervicovaginal cytology due to its rarity. We report a case of a cervical lymphoma in a 65-year-old woman, which was diagnosed as a squamous cell carcinoma on cervicovaginal cytology.

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A case of ossifying fibromyxoid tumor (OFMT) evaluated during an intraoperative pathological consultation is presented. The patient, a 70-year-old woman was being followed because of a tumor in the left buttock. Cytological smears were obtained after scrapping the tumoral cut surface and revealed a myxoid background with fragments composed of a denser, fibrillar metachromatic stroma with accompanying round to oval tumoral nuclei and no vessels. Single cells were predominantly monomorphic with a round to oval morphology and scarce cytoplasm. The most relevant feature of the tumor was its peripheral, plaque-like, calcified consistency. The review of the cytological descriptions of four cases revealed similar findings that can be presumed as those of a low-grade myxoid tumor of round to oval cells. A specific recognition of OFMT based solely on cytological features seems difficult. However, when such features are coupled with characteristic radiological findings (peripheral calcification) this entity must be considered.

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Background: Cytology plays an important role in the preoperative assessment of many cancers. It is used as a first-line pathological investigation in both screening and diagnostic purposes. Aims: To determine the diagnostic value and accuracy of touch imprint cytology (TIC) smear of prostate core needle biopsy (CNB) specimens in the diagnosis of prostate carcinoma. Materials and Methods: One hundred and twenty-one patients had ultrasound-guided transrectal prostate CNB. A total of 1210 TIC smears were prepared from all CNB specimens. Results: Diagnoses of 1210 TIC smears were compared with the histopathological findings of the CNB specimens. One hundred and seventy (14%) TIC smears were found positive for malignancy, 35 (2.9%) were diagnosed as suspicious for malignancy and 1005 (83.1%) were found negative for malignancy. Twenty-five of 35 suspicious imprints and 150 of 170 malignant smears were confirmed to be malignant on histopathological evaluation. Although 20 malignant TIC smears were defined as benign in standard histological preparations, 10 of them had definitive diagnosis of malignancy following extensive serial sectioning. Last of all, there were 10 false-positive cytology results. Moreover, 10 of the 35 suspected TIC smears were false negative when compared with the histopathological diagnosis. The sensitivity, specificity, positive predictive value and negative predictive value of touch imprint smear results were 100%, 98%, 90.2% and 100%, respectively. Conclusions: TIC smears can provide an immediate and reliable cytological diagnosis of prostate carcinoma. It may clearly help the rapid detection of carcinoma, particularly in highly suspected cases that had negative routine biopsy results for malignancy with abnormal serum prostate specific antigen (PSA) levels and atypical digital rectal examination.

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A case of lymphoepithelial carcinoma (LEC) occurring in right submandibular gland of a 13-year-old Indian male is presented, wherein the lesion unveiled itself only after multiple fine needle aspiration (FNA) procedures. This unusual neoplasm has high frequency of occurrence in Eskimos and a predilection for the parotid gland. The aspirates obtained were highly cellular comprising tight clusters of atypical epithelial cells with admixture of lymphocytes. Histopathological examination of the resected submandibular gland and lymph node chain was consistent with the diagnosis of LEC. Immunohistochemistry (IHC) revealed cytokeratin (CK)-positive and S-100-negative tumor cells lying admixed with CD45-positive lymphoid cells. A detailed otorhinolaryngological examination with inclusion of multiple biopsies was found negative for any primary tumor. Although histopathological features of this entity are well established, only a handful of case reports describing cytological features of this entity are present in medical literature. We conclude that the cytomorphological features of LEC are sufficiently distinctive to at least, suggest a possibility of this lesion.

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Fungi have emerged as important etiological agents for chronic sinusitis. Invasive aspergillosis has been reported in immunocompromised individuals or diabetics; however, it is uncommonly seen in immunocompetent patients. Definitive diagnosis of these lesions is based on histological examination and fungal culture. We report two cases of invasive maxillary lesions in immunocompetent patients, clinically suspected of malignancy; however, fine needle aspiration cytology showed fungal hyphae, morphologically suggestive of Aspergillus, which was later confirmed on histopathology. Aspiration cytology thus plays a crucial role in the early and definitive diagnosis of fungal sinusitis in cases clinico-radiologically suspected of malignancy. An early diagnosis will help the clinician for early and appropriate management and follow-up in order to decrease the high morbidity and mortality associated with it.

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Background: Methodical and meticulous understanding of clinico-pathological procedures and decision making process of cancer diagnosis and identification of aspects that are well-suited for computer-aided analysis are first steps toward development of assistive computational tool for analysis of breast fine needle aspiration cytology (FNAC) slides. Aims: To identify variables in practice of FNAC as used for diagnosis of breast lesions and commonly perceived diagnostic significance of cytological features for diagnosis of benign or malignant condition of breast lesions. Materials and Methods: An India-wide questionnaire-based survey of cytopathologists/pathologists' breast FNAC reporting practices and their opinion on diagnostic significance of cytological features in diagnosis of benign or malignant nature of breast lesion were conducted. Results: Fifty-one experts working with various medical education institutes (~52% of participants), oncological tertiary care centers (~28%) and primary care centers/private diagnostic pathology laboratories (~20%) spread over 13 states of India have participated in the survey. Constants and variables observed in clinico-cytopathological practices and combined opinion of the participants on diagnostic significance of cytological features are presented here. Conclusions: There exist analogous as well as varied components in clinico-pathological procedures and diagnostic interpretation by individuals. These constants and variables in the practice of breast FNAC should be considered, when drawing up specifications for an assistive computational tool for analysis of breast FNAC slides. The estimate for commonly perceived significance of cytological features obtained through this study will help in their selection for computer-aided analysis of breast FNAC slides and further in selection of corresponding feature quantification techniques.

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The "gold standard" for the diagnosis and classification of leprosy to date, is histological examination of skin biopsy in correlation with the bacteriological indices. These are, however, time-consuming. An attempt was made to diagnose leprosy using fine needle aspiration cytology (FNAC) which is a simple, safe, cost-effective and time-saving procedure with minimal trauma and complications. This case report highlights the role of FNAC in rapid diagnosis and early management, in patients of leprosy.

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Background: Microscopy detection of acid fast bacilli (AFB) by Ziehl-Neelsen (ZN) method has many advantages when it comes to speed and feasibility though it has a low sensitivity. If the sensitivity could be improved, it has the potential to become an even more valuable tool for detection of AFB. Objectives: To evaluate the efficacy of bleach concentration method in the cytodiagnosis of tuberculous lymphadenitis in comparison with routine Ziehl-Neelsen method and to compare the positivity in various cytomorphological categories. Materials and Methods: A total of 112 cases of tuberculous lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) were categorized into six cytomorphological patterns. The acid-fast bacilli positivity by routine staining was correlated with modified bleach methods of ZN staining. Sensitivity of routine ZN and modified bleach concentration was compared. Results: The classic cytomorphological pattern of tuberculosis of epithelioid granulomas, langhans giant cells and caseous necrosis was seen in 37.5% of cases. Routine ZN staining detected AFB in 12.5% of cases and the modified bleach method in 60.7%. Modified bleach method showed AFB positivity in additional 54 cases where routine AFB staining was negative. The modified bleach method showed AFB positivity in all cases where routine ZN staining was positive. Conclusion: The modified bleach method was more sensitive and safer than routine ZN staining. As the background was clear, the bacilli were easily visible and the screening time was shorter.

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