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2014| October-December | Volume 31 | Issue 4
Online since
February 10, 2015
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CASE REPORTS
Oncocytic papillary cystadenoma of major salivary glands: Three rare cases with diverse cytologic features
Susie Chin, Hee Kyung Kim, Jeong Ja Kwak
October-December 2014, 31(4):221-223
DOI
:10.4103/0970-9371.151140
PMID
:25745293
Oncocytic papillary cystadenoma (OPC) in the major salivary glands is extremely rare. We report three cases of these cystadenomas arising in major salivary glands, with varied cytologic features. Case 1: A 38-year-old man presented with a right parotid gland mass that showed papillary clusters of oncocytic cells on cytologic examination. Case 2: An 84-year-old man presented with a left parotid gland mass. Cytology revealed an acellular smear. Case 3: A 57-year-old man presented with a mass in the right submandibular gland. Cytology revealed irregular sheets of epithelial cells. Histologic diagnoses of OPC were made for all three cases.
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ORIGINAL ARTICLES
Role of rapid on-site evaluation with cyto-histopathological correlation in diagnosis of lung lesion
Smita Chandra, Harish Chandra, Girish Sindhwani
October-December 2014, 31(4):189-193
DOI
:10.4103/0970-9371.151128
PMID
:25745282
Aim:
This study was conducted to assess the role of cytology in the diagnosis of lung lesions and to compare it with histopathology. It was also intended to evaluate the role of rapid on site evaluation (ROSE) as an adjunct to cytological diagnosis of lung lesions.
Materials and Methods:
The study included all the cases of lung lesions, which were diagnosed on cytology followed by histopathology over a period of 2½ years along with ROSE, wherever possible.
Results:
Cytology was done in total 782 cases of various lung lesions and of this cyto-histopathological correlation was available in 215 cases. ROSE was done in 93.4% of total cases and smears were considered on the site adequate in the first pass in 68.1% cases and in second pass adequacy increased to 93.4%. The diagnostic accuracy of cytology was 75.3%, and that of histology was 86.9% in the diagnosis of lung lesions. The diagnostic accuracy of cytology for squamous cell carcinoma (94.4%) and adenocarcinoma (96.5%) was higher than that of histology.
Conclusion:
Cytology is comparable to histology in the diagnosis of lung lesions and may even outperform biopsy in lung tumor diagnosis. The advantages of cytology may be further added by better sampling and preanalytical assessment for adequate diagnostic material and ROSE has proved to be an important, easy and cost effective adjunct in this regard. A multidisciplinary approach involving pulmonologist, radiologist and cytopathologist with ROSE, followed by vigilant morphological examination may increase diagnostic utility of cytology for lung lesions.
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Integrated cervical smear screening using liquid based cytology and bioimpedance analysis
Lopamudra Das, Tandra Sarkar, Ashok K Maiti, Sukla Naskar, Soumen Das, Jyotirmoy Chatterjee
October-December 2014, 31(4):183-188
DOI
:10.4103/0970-9371.151127
PMID
:25745281
Objective:
To minimize the false negativity in cervical cancer screening with Papanicolaou (Pap) test, there is a need to explore novel cytological technique and identification of unique and important cellular features from the perspectives of morphological as well as biophysical properties.
Materials and Methods:
The present study explores the feasibility of low-cost cervical monolayer techniques in extracting cyto-pathological features to classify normal and abnormal conditions. The cervical cells were also analyzed in respect to their electrical bioimpedance.
Result:
The results show that newly developed monolayer technique for cervical smears is cost effective, capable of cyto-pathological evaluation. Electrical bioimpedance study evidenced distinction between abnormal and normal cell population at more than two order of magnitude difference.
Conclusion:
The integration of bioimpedance observation along with the proposed low-cost monolayer technology could increase the efficiency of the cervical screening to a greater extent thereby reducing the rates of faulty diagnosis.
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CASE REPORTS
Primary thyroid lymphoma: A rare disease
Deepti Verma, Vandana Puri, Shilpi Agarwal, Aasha Bhaskar
October-December 2014, 31(4):218-220
DOI
:10.4103/0970-9371.151139
PMID
:25745292
Primary thyroid lymphomas are rare neoplasms comprising of 1-5% of thyroid malignancies. These are predominantly B-cell in origin. Here, we report a case of 60 years lady, a known case of lymphocytic thyroiditis, diagnosed as thyroid lymphoma (diffuse large B-cell) on fine needle aspiration and confirmed histopathogically and immunohistochemically. She presented with a sudden increase in thyroid swelling. Fine needle aspiration performed showed highly cellular smears comprising predominantly of the monomorphic population of medium to large sized lymphoid cells with high nuclear/cytoplasmic ratio and scant cytoplasm. A possibility of thyroid lymphoma possibly diffuse large B-cell lymphoma was suggested which was later confirmed on biopsy. Fine needle aspiration provides an easy mode for diagnosing large cell lymphoma like diffuse large B-cell. Hence, an early diagnosis is possible for a timely intervention. Also, cases of lymphocytic thyroiditis should be regularly followed for the development of lymphoma.
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Schwannoma of the parotid gland: Diagnosis by fine-needle aspiration cytology
Poonam Bhaker, Debajyoti Chatterjee, Debasis Gochhait, Bishan D Radotra, Pranab Dey
October-December 2014, 31(4):196-198
DOI
:10.4103/0970-9371.151130
PMID
:25745284
In this brief report, we have described a rare case of schwannoma of the parotid gland in a young female who presented to us with a 3 cm diameter parotid swelling. The fine-needle aspiration cytology showed small fascicles, clusters and discrete spindle-shaped cells with long wavy nuclei. The cytological diagnosis of schwannoma of the parotid gland was offered and later confirmed by excision and histopathology.
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A focal nodular Hürthle cell hyperplasia in Hashimoto's thyroiditis: A diagnostic dilemma on fine needle aspiration
Shirish S Chandanwale, Tanmayi V Kulkarni, Ruchir J Patel, Dhaval Thakkar
October-December 2014, 31(4):236-238
DOI
:10.4103/0970-9371.151145
PMID
:25745298
Hürthle cells are seen in a variety of nonneoplastic and neoplastic thyroid gland lesions. Number and morphology of Hόrthle cell vary in thyroid aspirate. Occasionally, thyroid aspirate in focal nodular Hόrthle cell hyperplasia in Hashimoto's thyroiditis exclusively comprise of Hόrthle cells and mimics Hόrthle cell neoplasm. Fine needle aspiration (FNA) diagnosis in such cases is challenging. A 60-year-old female presented with goiter and clinical features of hyperthyroidism. FNA smears showed Hόrthle cells arranged in flat sheets and lying singly with occasional lymphocytes in Hόrthle cell sheets. Repeat aspiration from other site showed lymphocytes, infiltrating the thyroid follicular cells. We conclude that a careful search of lymphocytes in Hόrthle cell sheets in cytology smears, multiple aspirates, associated clinical findings and ancillary techniques reduce the diagnostic pitfall and avoid unnecessary surgery.
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Cytodiagnosis of epithelioid malignant melanoma (amelanotic) and diagnostic dilemmas
Santosh Kumar Mondal, Palash Kumar Mondal, Sujit Kumar Dutta
October-December 2014, 31(4):207-209
DOI
:10.4103/0970-9371.151134
PMID
:25745288
Melanoma is an aggressive neoplasm, and early diagnosis can reduce mortality in such patients. Diagnosis may be delayed in amelanotic tumors. We present one such case, a 35-year-old lady with a rapidly growing mass over the right angle of mandible. Fine-needle aspiration cytology was done, and smears showed discretely arranged large epithelioid cells with high N:C ratio, prominent single to multiple nucleoli. Occasional binucleated and multinucleated tumor giant cells were also noted. Poorly differentiated carcinoma, high-grade non-Hodgkin lymphoma, amelanotic melanoma, and pleomorphic sarcoma were included as differential diagnoses. Immunocytochemistry (ICC) revealed Melan-A/MART-1 positivity in some cells and S-100 positivity in most tumor cells. Desmin, pancytokeratin, and leukocyte common antigen were negative. Based on cytomorphological features and ICC findings, a diagnosis of epithelioid variant of amelanotic melanoma was rendered. Later on, true cut biopsy and histologic examination of excised specimen and adjunct immunohistochemistry with positive Melan-A and S-100 confirmed the diagnosis.
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Axillary node metastasis from primary ovarian carcinoma
Trupti S Patel, Chintan Shah, Majal C Shah, Manoj J Shah
October-December 2014, 31(4):202-204
DOI
:10.4103/0970-9371.151132
PMID
:25745286
Metastasization and distinction from mammary carcinoma is of great clinical importance because of different treatment modalities. Here, we discuss a case of stage IIIC ovarian serous carcinoma, presenting with bilateral axillary nodes metastasis after 25 months interval of its initial presentation. Increased serum CA-125 level caused clinical suspicion. Computed tomography scan of abdomen and pelvis showed no residual disease or any abdominal lymphadenopathy. Mammography of both breast were normal. Bilateral axillary nodes were noted. Guided fine needle aspiration cytology (FNAC) and biopsy of ovarian carcinoma to axillary node is a rare event. Its recogn done. Cytomorphology revealed poorly differentiated carcinoma, compatible to that of primary ovarian tumor. Thus, metastatic carcinoma to axillary node from ovary was confirmed. This case illustrates a rare metastatic presentation of ovarian carcinoma and unequivocal role of FNAC to provide rapid diagnosis and preferred to be first line diagnostic procedure.
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Tenosynovial giant cell tumor presenting as a parotid gland mass: Expanding the differential diagnosis of giant cell-rich lesions in salivary glands
Ling Guo, Shadi Qasem, Simon Bergman, Ziyan T Salih
October-December 2014, 31(4):224-226
DOI
:10.4103/0970-9371.151141
PMID
:25745294
Tenosynovial giant cell tumors (TGCT) are rare benign soft tissue tumors affecting mostly young adults. The most common affected sites include the knee, ankle, elbow, shoulder, and fingers. The temporomandibular joint is occasionally affected. Herein, we report a case of a 31-year-old Caucasian male who presented clinically with a parotid gland mass. The initial clinical and radiological work-up failed to reveal any involvement of the adjacent temporomandibular joint. Fine-needle aspiration revealed a cellular tumor composed of mononuclear and multinucleated giant cells with fibrosis and hemosiderin deposition. This was subsequently found to be a TGCT arising from the temporomandibular joint. Giant cell-rich lesions are uncommon in salivary glands. Herein, we describe the cytomorphology and clinico-radiographic features of this tumor with emphasis on the differential diagnosis of giant cell-rich lesions presenting in salivary glands. Despite its rare occurrence, this entity should be considered when giant cells are prominent in specimens acquired from this location.
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IMAGES IN CYTOPATHOLOGY
Crystalloids in salivary gland lesions
Reeba Mary Issac, Annamma Madathil Oommen, Jessy Mangalathu Mathai
October-December 2014, 31(4):194-195
DOI
:10.4103/0970-9371.151129
PMID
:25745283
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CASE REPORTS
Rosette forming glioneuronal tumor of the fourth ventricle in squash cytology smear
Amita Radhakrishnan Nair, Chittoor Viswanathan Gopalakrishnan, Tirur Raman Kapilamoorthy, Neelima Radhakrishnan
October-December 2014, 31(4):215-217
DOI
:10.4103/0970-9371.151138
PMID
:25745291
Rosette forming glioneuronal tumor (RGNT) is a recently recognized and extremely rare glioneuronal tumor occurring in the fourth ventricle. It is crucial for the cytopathologist to be aware of this entity as it can be easily mistaken for more common neoplasms occurring at this site. We present here the cytology of such a rare case of RGNT that was misdiagnosed as ependymoma. The varying cytological features of this entity, as well as the common diagnostic difficulties encountered in cytology, are highlighted in this report.
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An unusual presentation of Langerhans cell histiocytosis
Palak Agarwal, Manju Kaushal
October-December 2014, 31(4):227-229
DOI
:10.4103/0970-9371.151142
PMID
:25745295
Langerhans cell histiocytosis (LCH) is a relatively rare and unique disease. An incidence of 7.9% in the jaws is reported. We report a case of 9-year-old male child referred to us from dental outpatient department, who presented with a firm swelling in right lower jaw along with bilateral submandibular lymphadenopathy for 1-month. Fine-needle aspiration was done from lytic lesion in the body of mandible and multiple smears were prepared. On the basis of the clinical and cytomorphological findings, a diagnosis of LCH was suggested. The diagnosis was confirmed on histology. Thus, a high possibility of LCH should be considered in children presenting with lytic lesions in head and neck region.
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Fine-needle aspiration cytology of metastatic squamous cell carcinoma thyroid: A rare entity
Reetu Kundu, Rajpal Singh Punia, Harsh Mohan, Uma Handa, Nitin Gupta
October-December 2014, 31(4):210-212
DOI
:10.4103/0970-9371.151135
PMID
:25745289
Metastasis to the thyroid gland is rare with majority of cases discovered during an autopsy. Clinical presentation with a palpable thyroid or functional disturbances in thyroid is uncommon. We report isolated metastasis of laryngeal squamous cell carcinoma (SCC) to the thyroid gland diagnosed on fine-needle aspiration cytology which is minimally invasive and a preferred preliminary diagnostic modality in palpable thyroid swellings. A diagnosis of extra thyroidal SCC is a diagnosis of exclusion when there is no evidence of a coexistent recognizable primary thyroid cancer and/or molecular signatures suggestive of thyroidal origin.
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Isolated cutaneous cryptococcosis in clinically unsuspected idiopathic CD4 lymphocytopenia
Divya Sharma, Neha Singh, Seema Kaushal, Shyama Jain
October-December 2014, 31(4):230-232
DOI
:10.4103/0970-9371.151143
PMID
:25745296
Idiopathic CD4 lymphocytopenia first defined in 1992 by the U.S. Centers for Disease Control and Prevention, as the repeated presence of a CD4
+
T-lymphocyte count of fewer than 300 cells/cumm or of <20% of total T-cells with no evidence of human immunodeficiency virus (HIV) infection and therapy that might cause depressed CD4 T-cells. Most of the cases present with systemic opportunistic infections. We report a case without risk factors or laboratory evidence of HIV infection, presenting with cutaneous cryptococcal infection, diagnosed on cytology.
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Fine needle aspiration cytology of dermal cylindroma
Parikshaa Gupta, Pranab Dey, Amanjit Bal
October-December 2014, 31(4):213-214
DOI
:10.4103/0970-9371.151137
PMID
:25745290
In this paper, we have described fine needle aspiration cytology (FNAC) of a rare case of dermal cylindroma. A 40-year-old female presented with a lateral mid-cervical swelling fixed to the skin. FNAC smears showed multiple clusters of small, round to oval cells with hyperchromatic nuclei, inconspicuous nucleoli and scant cytoplasm. In addition, the background showed deposits of basement membrane type material. This was dark magenta colored pinkish globular material. The globules were occasionally surrounded by the basal type of cells. Occasional cells with elongated nuclei were also noted. Cytological diagnosis of skin adnexal tumor possibly cylindroma was offered. Subsequent histopathology of the swelling showed sheets and clusters of cells in a jigsaw puzzle-like fashion. Deposition of abundant basement membrane-like material was noted in between the tumor cells. A diagnosis of cylindorma was offered. FNAC along with the subcutaneous location of the tumor and absence of primary salivary gland tumor may help to diagnose such rare case.
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Fine needle aspiration of Histiocytic sarcoma
Varuna Mallya, Anju Bansal, Sujala Kapoor
October-December 2014, 31(4):205-206
DOI
:10.4103/0970-9371.151133
PMID
:25745287
Histiocytic sarcoma is derived from histiocytes and is among the rarest of the tumors affecting the lymphoid tissue. We report a case of a histiocytic sarcoma arising from the lymph node in a 35-year-old male who came for a fine needle aspiration cytology and a subsequent biopsy was conducted and the tissue subjected to hematoxylin and eosin and immunohistochemistry staining.
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Fine-needle aspiration cytology of recurrent epithelioid sarcoma of the foot: Role of immonocytochemistry in definitive diagnosis
Maithili Mandar Kulkarni, Sanjay Deshmukh, Vinod Patil, Siddhi Gaurish Sinai Khandeparkar
October-December 2014, 31(4):199-201
DOI
:10.4103/0970-9371.151131
PMID
:25745285
Fine-needle aspirations (FNA) have played a crucial role in the diagnosis and follow-up of malignancies including sarcomas. However, relatively low specificity in the classification of sarcoma is the main limitation of FNA. Epithelioid sarcoma is a rare tumor of soft tissues. Very few individual case reports describing cytological features of epithelioid sarcoma have been documented in the literature. Here, we describe cytological features of epithelioid sarcoma with immunocytohistological correlation.
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Cytology of secondary hemophagocytic lymphohistiocytosis masquerading as lymphoma in a nonimmunocompromised adult
Thondavadi Subbanna Rekha, Hassan Srinivasamurthy Kiran, Nandish Manoli Nandini, Sudharshan Murthy
October-December 2014, 31(4):239-241
DOI
:10.4103/0970-9371.151146
PMID
:25745299
Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal immune disorder which is uncommon in a nonimmunocompromised adult. A 27-year-old female who presented with fever, hematuria, generalized lymphadenopathy was clinically suspected to have lymphoma was subjected to fine needle aspiration of cervical lymph nodes. Cytology of lymph node had numerous histiocytes with phagocytosed lymphocytes, red blood cells and nuclear debris. A diagnosis of secondary HLH was made based on cytological findings, clinical manifestations, and laboratory results. She was treated with steroids and recovered completely. A high degree of clinical suspicion coupled with comprehensive cytology with fine needle aspiration cytology is fruitful in the diagnosis of HLH, a potentially fatal disease and help in the delineation of therapeutic regimen.
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Fine needle aspiration cytology of chondroblastoma of the fibula
Kamal Malukani, Shirish S Nandedkar, Prashant Yeshwante, Preeti Rihal
October-December 2014, 31(4):233-235
DOI
:10.4103/0970-9371.151144
PMID
:25745297
Chondroblastoma is a rare benign cartilaginous tumor typically seen in long bones, especially femur, tibia and proximal humerus. Extracortical soft tissue invasion or metastasis is rarely seen. We report here a unique case of chondroblastoma of the fibula with extracortical soft tissue invasion. Differential diagnosis on cytology is discussed.
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LETTER TO EDITOR
Anaplastic large cell lymphoma masquerading as rhabdomyosarcoma in fine needle aspiration cytology
Debasis Gochhait, Amanjit Bal, Pranab Dey
October-December 2014, 31(4):242-243
DOI
:10.4103/0970-9371.151147
PMID
:25745300
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© <%=year(date())%> Journal of Cytology |
Indian Academy of Cytologists
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