Background: Liquid-based cytology (LBC) is fast becoming a useful method in evaluating both gynecological and non-gynecological preparations, including fine needle aspiration (FNA) cytology. Even distribution of cells, decreasing obscuring background elements like blood and mucus, well preserved nuclear and cytoplasmic details and rapid fixation helps in better visualization of cells. Aim: This study was conducted to asses the diagnostic accuracy of liquid-based cytology versus conventional smears in fine needle aspiration samples. Study Design: In this prospective study, we had 110 cases, including 30 cases of breast, 40 of lymph node, 10 of salivary glands, 18 of thyroid and 12 of bone and soft tissue. In each case, two passes were performed. The first pass was for conventional preparation (CP) and the second pass yielded material for thin-prep (TP) preparation. Both CP and TP smears were compared for cellularity, background blood and necrotic cell debris, cell architecture, informative background, presence of a monolayer of cells and nuclear and cytoplasmic details by a semiquantitative scoring system. Wilcoxon's signed rank test on an SPSS program was used for statistical analysis. Results: Diagnostic accuracy was better in LBC smears compared with CP smears due to lack of background debris and better cell morphology, which was performed according to Wilcoxon's signed rank test, yielding a P-value of <0.001. However, in some cases, because of a decrease in cell size, clustering and altered background in LBC, a support of CP was essential. Conclusion: LBC performed on FNA samples can be a simple and valuable technique. Only in few selected cases, where background factor is an essential diagnostic clue, a combination of both CP and TP is necessary.

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Background: Studies on ultrasonography (USG) guided fine needle aspiration cytology (FNAC) have been conducted in specialized settings such as thyroid, breast, and intra-abdominal aspirates. There is a paucity of literature on the practices of guided FNAC in a general cytopathology service. Aim: The aim was to determine prevailing practices of USG guided FNAC in a general cytopathology service of a teaching hospital. Settings and Design: Metropolitan hospital, clinical audit. Materials and Methods: Audit of 112 USG guided percutaneous FNAC done over 12 months. Statistical Analysis: Data were coded, entered in an excel spreadsheet and analyzed by translating into percentages and proportions. Results: The 112 guided FNACs included constituted 36 thyroid (32.14%), 45 intra-abdominal (40.17%), 11 breast (9.82%), 10 superficial lymph node (8.92%) and 10 soft tissue and miscellaneous (8.92%) lesions. Previous freehand FNAC was documented on the requisition forms in 14 cases. The reports were: Inadequate 33 (29.46%), nondiagnostic descriptive 35 (31.25%) or diagnostic 44 (39.28%). Inadequacy rates of aspirates from thyroid were 11 (30.56%) breast were 2 (18.18%), and intra-abdominal lesions were 13 (28.88%). Majority of the reports were nonstructured: 108 (96.42%) and nonrecommendatory: 101 (90.17%). Conclusions: Reporting practices varied and did not conform to a uniform structure. The inadequacy rates of breast and thyroid aspirates were comparable to the rates in the literature. Comparable studies were not available for intra-abdominal aspirates.

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Aim: To determine the correlation between the results of thyroid fine-needle aspirations interpreted using the Bethesda system and final histopathological reports for patients at an oncology hospital (OH) and non-oncology hospitals (NOHs). Materials and Methods: A retrospective, cross-sectional, descriptive study was performed to compare the cytology and histopathology results for patients with thyroid nodules in three Colombian hospitals. The final correlation of diagnoses between the two methods is reported. In Colombia, the health system provides the existence of general care hospitals and hospitals specializing in care of patients with cancer. Results: A total of 196 reports were reviewed, of which 53% were from OH and 47% were from NOHs. A greater proportion of category V (37.5%) was diagnosed at the OH, whereas NOHs diagnosed a greater proportion of category II (42.3%). The global correlation between diagnoses made using cytology and histopathology was 93.3% for categories V and VI (based on the final malignant diagnosis) and 86.9% for benign category II. Significant differences between institution types were observed when category IV and V and malignant histopathology were compared (56.3% OH vs. 23.5% NOH; P = 0.05 for category IV, 97.4% OH vs. 82.3% NOH; P = 0.03 for category V), while no significant difference between institution types was observed when category II and final benign diagnosis were compared (P = 0.6). Conclusions: The Bethesda system for thyroid cytology correlates adequately with final histopathological diagnosis in Colombia. Significant differences were identified in the diagnostic correlation for malignant lesions between the OH and NOHs in categories IV and V caused by selection bias of the population.

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Background: Grading and hormone receptor determination in breast carcinoma are predictive factors for response to hormonal therapy. Aim: This study was undertaken to grade breast carcinoma and to determine estrogen receptor (ER) and progesterone receptor (PR) expression on fine-needle aspiration cytology (FNAC). Furthermore, the objective was to compare the results with histological grading and immunohistochemistry on surgical material. Materials and Methods: Fifty cases of breast carcinoma diagnosed on FNAC were included. The cytological grading was done according to the Robinson's grading system. The corresponding histology sections were graded using the modified Bloom-Richardson system. Immunostaining for ER and PR was done on smears and tissue sections. Results: On both cytological and histological evaluation, 49 cases were infiltrating ductal carcinoma and one case was colloid carcinoma. On comparing cytological and histological grading, 78% were correctly graded on cytology. The sensitivity, specificity, positive predictive value and negative predictive value for ER detection on immunocytochemistry (ICC) were 55.6%, 95%, 93.8% and 61.3%, respectively. The sensitivity, specificity, positive and negative predictive value for PR detection on ICC were 57.7%, 95.2%, 93.8% and 64.5%, respectively. The correlation for ER and PR between cytology and histology was 72.3% and 74.5%. Conclusion: The grading along with ER and PR immunostaining of breast carcinoma on smears is advocated because of high concordance between cytology and histology. This allows the patient to be treated with hormonal therapy on the basis of FNAC alone.

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Endometriosis is defined as the presence of a functioning endometrium outside the uterus. Abdominal wall endometriosis is a rare entity. Most of the abdominal wall endometriosis occurs in or around surgical scars following caesarean section or hysterectomy. We report a case of scar endometriosis following caesarean section and diagnosed by fine needle aspiration cytology (FNAC). Excision biopsy confirmed the FNAC diagnosis of scar endometriosis.

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Background: Mucoepidermoid carcinoma (MEC) is a malignant salivary gland neoplasm with extreme morphologic heterogeneity and hence rendering a definitive fine needle aspiration cytology (FNAC) diagnosis of this neoplasm is really challenging. The present study was undertaken to elucidate the cytological features of MEC and explore the diagnostic accuracy and pitfalls by comparing with subsequent histopathology. Materials and Methods: The present study was conducted over a period of 2 years wherein we obtained six histopathologically confirmed cases of MEC. These patients were initially subjected to FNAC. The cytologic features studied included presence of mucous cells, intermediate cells, and squamous cells. Presence of background mucinous material was also noted. The cytological features were compared with the subsequent histopathology. Results: Of the 6 cases of MEC, a definite cytological diagnosis was possible only in 2 cases. Of the remaining 4 cases, 2 cases were broadly diagnosed in cytology as neoplasm with cystic degeneration and 2 cases were underdiagnosed as pleomorphic adenoma. Conclusions: A satisfactory aspirate with all three types of cells; mucous, intermediate and squamous cells may not be obtained in all cases of MEC for providing a definite diagnosis. Hence, a good clinicoradiological correlation, a high index of suspicion and repeated aspirations especially in cystic lesions may be particularly helpful in difficult cases. In addition, while dealing with mucinous cystic lesions with low cellularity, the importance of early excision should be communicated to the clinician since the possibility of low-grade MEC cannot be excluded.

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Primary non-Hodgkin lymphoma of the liver is a very rare malignancy. In this case report, we describe a case of primary hepatic lymphoma (PHL) in a 60-year-old man who presented with lump and pain in the abdomen of 2 months' duration. The patient had altered liver function, normal serum alfa fetoprotein level (AFP), normal hemogram and bone marrow. A computed tomography scan of the abdomen and pelvis showed an ill-defined hypodense mass with specks of calcification involving the liver, suggestive of primary malignant mass of liver. Diagnosis of PHL was established on the cytology smear and confirmed by immunohistochemistry on tissue biopsy. This case demonstrates that PHL should be considered in the differential diagnosis of space-occupying liver lesions in the presence of a normal level of AFP. Fine needle aspiration cytology is a faster and safer diagnostic modality even in such a rare case. The case has many unique features like negative serology for viruses, no type B symptom and normal lactate dehydrogenase level.

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Myxopapillary ependymoma (MPE) is a rare and distinctive tumor which occurs in the sacrococcygeal area of young adults and children, often intradural in location. Histopathologic features have been well-described in the literature whereas cytological findings have been sporadically reported by various authors mainly as case reports. We report the features of a primary sacrococcygeal MPE on aspirate cytology in a 45-year-old female. Cytology smears displayed a papillary pattern with the presence of fibrovascular cores, rimmed by cuboidal to columnar cells sending fibrillary cytoplasmic processes forming pseudorosettes along with the presence of hyaline globules, and myxoid material. Intranuclear inclusions, nuclear grooves, cytologic atypia or mitotic activity was not evident, in this case. MPEs need to be differentiated from the other tumors occurring in this location which may also show myxoid material and papillary fronds. Hence, the recognition of the characteristic cytologic features plays an important role in establishing a preoperative diagnosis.

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Superficial acral fibromyxoma (SAF) is a rare, distinctive benign soft tissue lesion that often involves the fingers and toes, with the great toe being the most frequently affected site. We report a case of SAF diagnosed by fine needle aspiration cytology and confirmed by histopathology. The pre-operative cytological diagnosis will help the surgeon to plan for a wider excision that prevents recurrence.

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Matrix producing carcinoma (MPC) of the breast is a very rare subtype of metaplastic carcinoma with heterelogous elements, which comprises <0.1% of invasive breast carcinomas. There are very few reports describing the cytological features of MPC. In this article, we aimed to discuss cytological, histopathological and immunohistochemical features of this rare entity in a 59-year-old woman.

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Presence of endometrial glands and stroma in places other than the uterus is called endometriosis. It can be pelvic or extra-pelvic. Abdominal scar endometriosis is an extra-pelvic endometriosis that can occur after surgery involving the uterus. Post-caesarean section, scar endometriosis is a rare event. The diagnosis is frequently made only after excision of disease tissue. We present a case of post-caesarean section abdominal scar endometriosis presenting as a tumor on the abdominal wall, which was diagnosed by fine needle aspiration cytology and confirmed by cell block preparation.

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Sarcina is a Gram-positive anaerobic organism, having exclusively fermentative metabolism and has been associated with gastric outlet obstruction. We demonstrate the present case to highlight the presence of Sarcina with a coexisting gastric adenocarcinoma diagnosed on fine needle aspiration cytology.

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Renal Ewing sarcoma (ES) is a rare malignant tumor characterized by fusion of the EWSR1 gene with a member of the ETS family of oncogenes, arising at a specific chromosomal translocation. Diagnosis of ES can be problematic, especially from cytological or small bioptical specimens because the differential diagnoses comprising a diverse group of small round blue cell tumors (SRBCTs). We report a case of primary renal ES in a young male, which had a t(11;22) (q24;q12) chromosome translocation encoding a type2 EWSR1/FLI1 fusion transcript. The tumor cells showed diffuse cytoplasmic immunoreactivity for CD99 and diffuse nuclear immunoreactivity for NKX2.2, an important oncogenic transcriptional target of EWSR1/FLI1, not only in the histological, but also in the cytological specimens. From the results of this case, we speculate that NKX2.2, in combination with CD99, may be a useful immunocytochemical marker to distinguish renal ES from other SRBCTs of kidney.

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Polymorphous low grade adenocarcinoma (PLGA) is a malignant neoplasm that frequently occurs in the minor salivary glands in palate and oral cavity. We present a case of upper lip swelling with ulceroproliferative growth, clinically mimicking squamous cell carcinoma (SCC). Fine-needle aspiration cytology smears suggested PLGA, which was later confirmed on histopathology. Clinical presentation of PLGA may simulate SCC.

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Yolk sac tumor (YST) is a rare neoplasm that affects children and adolescents. Fine needle aspiration biopsy is an extremely useful procedure for the diagnosis of YST. Main objective is to describe the characteristic cytological features of fine needle aspirates of YST. We report a case of YST in a 4-year-old male child occurring at paravertebral region showing cytomorphological details.

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Yolk sac tumor is the most common germ cell tumor in infants and children. Majority of them arise in the gonads. Yolk sac tumor of undescended testis has been rarely diagnosed. We present a case of yolk sac tumor in right undescended testis in a 2-year-old child primarily diagnosed by fine needle aspiration cytology.

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Synovial sarcomas are rare tumors accounting for approximately 5-10% of soft tissue sarcomas. They occur predominantly in the extremities, followed by head and neck. Primary pulmonary sarcomas are very rare and comprise only 0.5% of all primary lung malignancies. The diagnosis is established only after sarcomas like primary lung malignancies, and metastatic sarcomas have been excluded. For synovial sarcomas that arise at unusual locations, a definitive diagnosis is challenging and requires the use of ancillary diagnostic procedures such as immunohistochemistry (IHC) and molecular genetic techniques for confirmation of diagnosis. We report a case of 29-year-old male who had right lower lobe lung mass. He underwent right lower lobectomy. Intraoperative squash smears revealed spindle cell sarcoma. Subsequent histopathology and IHC confirmed the diagnosis as synovial sarcoma. We report this case on account of its rarity and to emphasize the utility of intraoperative squash smears in the diagnosis of such cases, which has been under-utilized in clinical practice.

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Cutaneous metastasis from underlying carcinoma is relatively uncommon in clinical practice. A high index of suspicion is required to diagnose these lesions, as these lesions can mimic benign skin lesions and clinical findings may be subtle. Fine needle aspiration cytology (FNAC) is commonly employed for diagnosing these skin lesions. However, it is often difficult to aspirate adequate material from small papular lesions. In these clinical situations, fine needle non-aspiration cytology (FNNAC) is proposed as an alternative procedure. FNNAC eliminates the negative suction pressure employed in FNAC and decreases the dilution of tumor cells by blood and hence yields adequate diagnostic material. We report here a case in which FNNAC was used in place of FNAC in diagnosing papular skin lesions. This procedure was carried out in a treated patient of carcinoma breast who was on regular follow-up and presented to us with a 20-day history of papular skin lesions over the chest and back. This article enlightens the clinicians about the utility of FNNAC, which is a relatively uncommon procedure.

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Desmoplastic small round cell tumor (DSRCT) is a malignant neoplasm that most often presents in male adolescents as an abdominal mass. Cytological features have been previously described, but only two reports noted post chemotherapy changes on effusions. We report a case of a 15-year-old male with DSRCT status postchemotherapy that presented with ascitis. Unusual morphology was seen: Numerous malignant large and single cells with prominent nucleoli and abundant cytoplasm in a background without the stroma, occasional mitosis, and the abundant apoptosis. Cell block immunocytochemistry was confirmatory. Awareness of the postchemotherapy changes in this tumor will allow us to diagnose recurrence.

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