World Health Organization reporting system for lung cytopathology-A brief correspondence

The WHO lung cytopathology reporting system has been published recently and is now a five-tier category system without any subcategorization. WHO reporting system also encourages the application of ancillary diagnostic tests like cell block preparation, immunocytochemistry, and rapid on-site evaluation for better categorization of specimens and further management. This correspondence aims to provide a brief outline of the lung reporting system. Lung cytopathology reporting system use standardized nomenclature and usage of the terminologies harmonizing with the WHO Blue Book, and table and flow diagram may be helpful for the readers.

Upcoming World Health Organization system for reporting lymph node cytopathology-A preliminary outline

Purple book for WHO reporting for lymph node cytopathology - 2023. Lymph node cytopathology reporting system may use standardized nomenclature and usage of the terminologies harmonizing with the WHO Blue Book on hematolymphoid tumors.

Regular resident becomes aggressive enemy: Diagnosed on cytology

Actinomycosis, an oral cavity commensal, causes cervicofacial infection in patients associated with an immunosuppression state and local mucosal injuries. Bone involvement by this commensal is rare. In the present case, we report a case of left peri mandibular soft tissue, soft to firm, tender swelling in a 39-year-old immunocompetent male diagnosed as Actinomycosis infection on fine needle aspiration cytology (FNAC) and cell block preparation.

Urorectal Septum Malformation Sequence With Retroperitoneal Neuroblastoma: A Case Report of an Unusual Association

Urorectal septum malformation sequence (URSMS) is an uncommon disease characterized by a failure of the anorectal septum to divide the cloaca and fuse with the cloacal membrane. Complete URSMS is usually lethal in newborn due to severe renal dysfunction and pulmonary hypoplasia. Partial URSMS is compatible with life with a single perineal opening draining a common cloaca with an imperforate anus which amenable to surgical management. Antenatal diagnosis of URSMS is challenging because of multisystem, complex abnormalities involving gastrointestinal, urogenital tract, cardiovascular, and musculoskeletal systems. In this case report, we describe a 15-week male fetus with partial URSMS having a spectrum of multisystem structural anomalies associated with fetal neuroblastoma in retroperitoneal location and adrenal neuroblastoma in situ.

Diagnostic Performance of Bile Duct Brush Cytology with Risk of Malignancy of Standardized Categories in the Wake of World Health Organization Reporting System for Pancreaticobiliary Cytopathology: An Updated Systematic Review and Meta-Analysis

INTRODUCTION

The WHO Reporting System for Pancreaticobiliary Cytopathology revised the Papanicolaou Society of Cytopathology guidelines in alignment with the WHO classification of digestive system tumors, 5th edition. The current systematic review and meta-analysis have been conducted to accurately assess the performance of bile duct brush cytology and report the risk of malignancy (ROM) of each standard category by following the guidelines of diagnostic test accuracy meta-analysis.

METHODS

Medline/Pubmed and Cochrane databases were searched till June 8, 2023, with a strategy that included target site (pancreaticobiliary and related terms), diagnostic method (bile duct brushing and related terms), and keywords for diagnostic performance (for Cochrane database). Inclusion criteria included studies that have assessed bile duct cytology (BDC) for pancreaticobiliary duct stricture with a sample size of over 50, provided cytological diagnoses similar to the WHO system with details to deduce true positives, true negatives, false positives, and false negatives through subsequent final diagnoses (benign vs. malignant). The exclusion criteria were the fewer sample size, assessment through other cytological categories, limited data, and clinical setting. Two authors independently reviewed the result of the search strategy. The quality of the selected articles was assessed by the QUADAS-2 tool. Bivariate random-effects model was used to get the pooled sensitivity and specificity. Heterogeneity across studies was assessed using I-squared statistics, and potential sources were found using meta-regression. Pooled and a range of ROM in each category was analyzed.

RESULTS

Thirteen studies were included with 4,398 bile duct brushings. The pooled sensitivity is 0.437 (95% CI: 0.371-0.504), and the pooled specificity is 0.972 (95% CI: 0.943-0.987). The ROM in various categories are as follows: inadequate/nondiagnostic: 23-100% (pooled: 50.15%), benign/negative for malignancy: 22-70% (38%), atypical: 0-95% (66%), suspicious for malignancy: 74-100% (89%), malignant: 91-100% (98%).

CONCLUSION

Even with standard cytological categories, the sensitivity of BDC remains low. The review has analyzed and discussed potential causes of heterogeneity that will be helpful for future diagnostic studies.

Spectrum of cervicovaginal Pap smears in newly established tertiary care medical institute

Objectives

We undertook this study to find out the spectrum of the cervical smear pattern along with the clinical profiles of patients who underwent cervical Papanicolaou (Pap) smear evaluation in our newly started tertiary care center. We also tried to find the possible clinical cause for unsatisfactory smears and factors for epithelial cell abnormality.

Material and Methods

The present study was a retrospective observational study. Pap smears cases with their clinical findings mentioned on the requisition form and cytopathology observations were retrieved from the archives of the department of pathology. Fisher's exact test was used for statistical analysis.

Results

Five hundred and ninety-four cases were included in the study. The most common age group was 36- 40 years. White discharge per vaginum was the most common clinical presentation. The negative for squamous intraepithelial lesions or malignancy was the most common interpretation (86.87%). Cervical erosion had statistically significant associations with unsatisfactory smears, while bacterial vaginosis had with satisfactory smears. Epithelial cell abnormality was seen in 4.62% patients. We observed a statistically significant association of cervical mucoid discharge, and inflammation with "no epithelial cell abnormality" cases, while postmenopausal bleeding was associated with "epithelial cell abnormality" cases.

Conclusion

In the presence of clinical factors like cervical erosion, which may affect the quality of Pap smear, proper sampling techniques are to be used by health-care providers. The careful evaluation of Pap smears, especially in cases of cervical mucoid discharge, postmenopausal bleeding, and inflammatory smears is required to ensure that epithelial cell abnormalities are not overlooked.

Liesegang rings in kidney diseases- A Systematic Review

INTRODUCTION

Liesegang rings (LR) are concentric acellular lamellar structures, usually found in cystic and inflammatory tissues but can also be seen in neoplastic conditions. They have been mistakenly interpreted as various structures like psammomatous calcification, parasites, and algae. This study has aimed to systematically review and summarize the existence of LRs in both non-neoplastic and neoplastic conditions of the kidney. The systematic search in PUBMED, PUBMED CENTRAL, and EMBASE databases along with Google Scholar was performed by using Kidney, Liesegang Rings, or Liesegang structure or pseudo parasitic structure in combination with the Boolean operators ''and'' as searching terms. Data were collected for demographic characteristics and histopathology diagnosis. The search function was limited to human subjects. Two reviewers independently performed the eligibility assessment and data extraction. Eligibility inclusion criteria were all publications in the English literature worldwide related to Liesegang rings in association with kidney's non-neoplastic and neoplastic conditions, regardless of the years of publication. Also included were those cases whose full articles were unavailable, but the abstract was well-described, fulfilling our inclusive criteria. Eligibility exclusion criteria included LRs found elsewhere in the body organs apart from the kidney and availability of full text in a different language, non-human, and duplicate article/case.

METHOD

After the exclusion of the articles as per the exclusion criteria, the total articles that fulfilled the inclusive criteria were reviewed. In addition, all the articles were further cross-referenced for additional articles. All published papers retrieved from this search were considered for this review. A total of 22 records (26 cases) were found with a diagnosis of LRs in the kidney to date. Some articles were published as case series. Accordingly, 26 patients were reported to have Liesegang rings associated with kidney neoplastic and non-neoplastic conditions, 12 were male and 14 were female. For one case the gender was not mentioned. LRs presented a higher frequency in individuals between the 4th and 5th decades of life. No single case was reported in infants and younger children. Regarding predisposing factors for LRs, cystic fluid contents were the most common underlying condition.

RESULT

In our practice, we encountered an unusual case of a 55-year-old female with a complaint of pain in the left upper quadrant of the abdomen. The ultrasound revealed nephrolithiasis and chronic kidney disease for which a nephrectomy was performed. On the histopathological examination, there was an incidental finding of Liesegang rings and a papillary adenoma along with features of chronic pyelonephritis. Our review will provide insight into LRs in different spectrums of kidney diseases.

CONCLUSION

This study represents the first available systematic review of the literature demonstrating LRs in the kidney. Although Liesegang rings have no great clinical significance, nonetheless, their presence in both tissue and cytological specimens should be kept in mind while dealing with different lesions of the kidney as they are good mimickers of many organic and inorganic substances, parasites, and malignancies.

A Comprehensive Review of the Newest World Health Organization (WHO) Cytopathology Reporting Systems

World Health Organization cytopathology reporting system systems have proposed for the pancreatobiliary tract, lung, lymph node, and soft tissue aligned with the updates in the World Health Organization classification of Tumor series. Among them, the pancreatobiliary tract and lung specimen reporting system have been published recently and are now a 7-tier and 5-tier category system, respectively, without any subcategorization. World Health Organization reporting systems also encourage the application of ancillary diagnostic tests like cell block preparation, immunocytochemistry, and rapid on-site evaluation for better categorization of specimens and further management, especially in indeterminate (atypical and suspicious for malignancy) and malignant cytology categories. In this brief review, we aim to provide a brief outline of both the systems and their clinical risk-based management strategies.

Recurrent Plunging Ranula - A Rare Case Report

BACKGROUND

Plunging ranula is a variant of ranula, which present as a painless subcutaneous anterolateral neck mass and is located beyond the mylohyoid muscle. These swelling presentations with no intraoral component are extremely rare and rarely provide a diagnostic challenge.

CASE REPORT

An elderly male presented with painless neck mass in the cervical region for three months. The mass was excised, and the patient was doing well on follow-up. We report a case of recurrent plunging ranula without any intraoral component.

CONCLUSION

Whenever the intraoral component is missing in ranula, chances of misdiagnosis and mismanagement are high. Awareness of this entity and high index of suspicion is needed for accurate diagnosis and effective management.

Insufficient/inadequate category in breast cytology: Are the standardized guidelines of rapid on-site evaluation available to reduce its rate?

In 2017, the International Academy of Cytology announced a five-tier reporting system for breast fine-needle aspiration biopsy (FNAB) cytopathology. We observed the insufficient/inadequate cases rate varied from 2.05% to 39.89%, with a risk of malignancy varying from 0% to 60.87%. This wide range of variation poses a significant number of patients at risk due to delay in management. Some authors describe rapid on-site evaluation (ROSE) as a tool to reduce its rate. In this preliminary review, we also observed that there were no uniform guidelines available for ROSE to reduce the insufficient/inadequate category rate. We expect that cytopathologists will construct some uniform guidelines for ROSE in the future, which may help to reduce the rate of category 1.

Cytology of micropapillary mucinous carcinoma: A case report of a clinically and genetically distinct breast carcinoma variant

Micropapillary mucinous carcinoma (MPMC) is an uncommon histopathological variant of breast cancer accounting for approximately one-fifth of all mucinous breast carcinomas. In contrast to pure mucinous carcinoma, MPMC tends to affect younger women and is associated with decreased progression-free survival, higher nuclear grade, lymphovascular invasion, lymph node metastasis, and positive HER2 status. Typically MPMC histology shows micropapillary architecture with "hobnailing" of cells and reverse polarity. Very few publications document the cytomorphological findings of MPMC. We report a case of MPMC that was suspected in fine needle aspiration cytology (FNAC) and confirmed at histopathology.

Adoption of Rapid On-Site Evaluation (ROSE) in the routine evaluation of lung cytology specimens

Not applicable.

Parasitic larvae in bronchoalveolar lavage fluid in a non-immunocompromised patient

Strongyloides stercoralis is responsible for a significant human parasitic infection known as strongyloidiasis. In addition, pulmonary strongyloidiasis is one of the most critical signs of disseminated strongyloidiasis. In this instance, S. stercoralis was unexpectedly discovered in bronchoalveolar lavage fluid.

Cytohistological correlation and risk stratification of salivary gland lesions using the Milan System for Reporting Salivary Gland Cytopathology: A tertiary care centre experience

INTRODUCTION

Salivary gland neoplasms account for approximately 5% of head and neck tumours. The cytomorphology of fine needle aspiration material helps determine the preoperative assessment and risk stratification. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was developed to improve communication between the laboratory and treatment provider.

AIMS AND OBJECTIVE

In the present study, we stratified all salivary gland lesions according to the MSRSGC and evaluated each category's concordance and risk of malignancy (ROM).

MATERIALS AND METHODS

This was a 5 year retrospective study. First, all cases were assigned to one of the six MSRSGC categories. Then, following cytohistological correlation, the concordance rates and ROM were calculated based on the final histopathology report.

RESULTS

A total of 354 cases were identified, with ages ranging from 2 to 88 years and the commonest age group was the 3rd to 4th decades. Categories I, II, III, IVA, IVB, V, and VI comprised 5.37% (19/354), 26.84% (95/354), 1.13% (04/354), 51.41% (182/354), 1.98% (07/354), 1.13% (04/354), and 12.15% (43/354) of the cases, respectively. The overall concordance rate between the cytological and histopathological diagnoses was 81.25% (65 out of 80 cases), with the sensitivity, specificity, positive predictive value, and negative predictive value at 43.48%, 96.49%, 83.33%, and 80.88%, respectively.

CONCLUSION

The MSRSGC provides a better objective and structured way to communicate with the health care provider. In our study, the overall concordance rate was observed in 62/80 cases, with maximum concordance seen in categories III, IVB, and V of the MSRSGC.

Osteoarticular tuberculosis: A series of six cases diagnosed on fine-needle aspiration cytology

A few studies are dealing with the role of fine-needle aspiration cytology in diagnosing osteoarticular tuberculosis (TB). The present study was undertaken to study the cytomorphological features of six cases of osteoarticular TB throughout 1 year, diagnosed by fine-needle aspiration cytology. The Papanicolaou, Giemsa, Ziehl–Neelsen, and periodic acid–Schiff stains were used in each case. The sampled material was also cultured in Lowenstein– Jensen media for Mycobacterium species and polymerase chain reaction assay for Mycobacterium tuberculosis. Histopathological findings were correlated whenever available. There were four male and two female patients. The age of the patients ranged from 15 to 53 years, with a mean age of 37 years. Most cases involved small bones (4/6) and long bones of upper and lower limbs (2/6). Radiologically, the suspected lesions presented as osteolytic lesions, fractures, and joint destruction. The smears showed epithelioid cell granulomas in 5 out of 6 cases (83.3%), multinucleate and Langhans’ giant cells in 3 out of 6 cases (50%), and only necrosis in 1 case (16.7%). Inflammatory cells were seen in the background in 5 out of 6 cases (83.3%). AFB was positive in 3 cases (50%). Culture in Löwenstein–Jensen media, done in three cases, showed growth of M. tuberculosis. PCR showed positivity for M. tuberculosis in all six cases. Fine-needle aspiration cytology is an easy procedure that can be used for the diagnosis of osteoarticular tuberculosis. Cytomorphologically, smears show epithelioid cell granulomas, multinucleated and Langhan’s’ giant cells, and necrosis.

The International Academy of Cytology standardized reporting of breast fine-needle aspiration biopsy cytology: A 2 year's retrospective study with application of categories and their assessment for risk of malignancy

Objectives

Breast cancer is the most common cancer in women worldwide. The fine-needle aspiration biopsy (FNAB) may be used as the first-line pathological investigation for evaluation and early diagnosis of the breast lesion. The FNAB helps to differentiate malignant from benign lesions. In the present study, we categorized the breast FNAB cases according to the International Academy of Cytology Yokohama System (IACYS) for reporting breast FNAB cytology and to assess the risk of malignancy (ROM) for each category.

Material and Methods

A retrospective data of breast lesions were retrieved from the archives of pathology department between January 2018 and December 2019. The study got approval from the Institutional Ethics Committee. Only 123 cases with cytology and histopathological correlation were included in this study. The cytological category was given according to IACYS for reporting breast FNAB cytology.

Results

The FNAB results were include as insufficient material 3.25% (4/123), benign 46.34% (57/123), atypical 12.2% (15/123), suspicious for malignancy (SM) 4.88% (6/123), and malignant 33.33% (41/123). The ROM was 50%, 7.27%, 40.0%, 83.33%, and 97.5% for NS, benign, atypical, SM, and malignant, respectively.

Conclusion

FNAB is an important tool in the diagnosis and management of breast lesions, especially in financial constrained developing countries like India with limited resources, where practice of core needle biopsy is limited. The 5-tier IACYS for reporting breast FNAB improves the reproducibility of cytology reports across the world and helps in triaging the breast lesion patients.

Anorectal Melanoma-Brownish Black Mass Not Always a Hemorrhoid

The non-specific clinical symptoms of anorectal brownish-black mass do not help to differentiate colorectal cancer, hemorrhoids, rectal ulcers which result in a delayed diagnosis or lead to inadequate management of lethal anorectal melanoma. Primary malignant melanoma of the anorectal region is an uncommon tumor, constituting approximately 1% of anal canal tumors which may be misdiagnosed clinically as hemorrhoids. Because of aggressive behavior and poor prognosis, efficient and prompt diagnosis is required in these cases. We report 2 cases of this rare tumor.

Malignant Phyllodes Tumour with Rhabdomyosarcomatous Differentiation: A Rare Phenomenon

Phyllodes tumour is a rare tumour of the breast constituting less than 1% of all breast tumours. Malignant Phyllodes Tumour (MPT) accounts for only 10-30% of all phyllodes tumours. Heterologous sarcomatous differentiation in a MPT is an infrequent phenomenon, with the cases reported showing differentiation mostly towards liposarcoma, fibrosarcoma, angiosarcoma, osteosarcoma, or chondrosarcoma. MPTs with rhabdomyosarcomatous differentiation are scarcely seen with only three confirmed cases documented till date to the best of the knowledge after a thorough search of literature. Here, authors present a case of 45-year-old female who presented with a well-defined rapidly growing lump in the right breast for last one year. A core needle biopsy performed showed a sarcomatous picture on histology. Complete excision was subsequently done. On microscopy, most of the areas showed fibrosarcomatous changes with frequent mitoses. Some of the foci showed large pleomorphic cells in diffuse sheets that were polygonal with densely abundant eosinophilic cytoplasm and vesicular nucleus with prominent nucleoli (rhabdomyoblasts). Myogenin was diffusely positive on Immunohistochemistry (IHC). A diagnosis of MPT with rhabdomyosarcomatous differentiation was made. This case is reported here for its unusual presentation and to make pathologists aware of this rare heterologous differentiation of MPT.

Primary pituitary tuberculosis

Tuberculosis is an infectious disease that involves any organ. However, the primary pituitary tuberculosis is an extremely rare disease. Intracranial tuberculomas account for 0.15-5% of intracranial space-occupying lesions, of which, pituitary as the primary site is unusual, and easily misdiagnosed as pituitary adenoma. In this setting, the late diagnosis can result in permanent endocrine dysfunction. We report the case of a 50-year-old woman who presented to the neurosurgery outpatient department with complaints of progressively increasing headache and diminished vision over the last year. On the clinical examination, the patient was conscious and oriented. The routine hematological and biochemical workup showed an increased erythrocyte sedimentation rate (ESR) and increased prolactin levels. The radiological working diagnosis was consistent with pituitary macroadenoma. No other radiological and/or clinical clue that could elicit the suspicion of pulmonary or extrapulmonary lesions of tuberculosis was found. The transsphenoidal endonasal tumor excision was done. The histopathology showed numerous epithelioid cell granulomas, Langhans giant cells along with scant necrosis. Ziehl Neelsen staining demonstrated acid-fast bacilli, and the final diagnosis of pituitary tuberculoma was made. We report this rare case of pituitary lesion that may be included in the differential diagnosis of sellar lesions to avoid unnecessary surgical interventions, especially in regions where the disease is endemic.

Malignant glomus tumor of the index finger

Glomus tumor (GT) is a benign mesenchymal tumor with an estimated incidence of 1.5 to 2% of soft tissue tumors. The majority of glomus tumors are benign and are mostly seen in the superficial skin & soft tissue of upper and lower distal extremity. The malignant variant of the glomus tumor is scarce. We report a case of a recurrent glomus tumor diagnosed in a 28-year-old male patient, who complained of painful swelling in the proximal phalanx of the right index finger. The magnetic resonance imaging of the hand revealed a well-defined multilobulated soft tissue mass at the palmar aspect of the 2^nd digit along the shaft of the proximal phalanx. Histopathology revealed a well-circumscribed tumor arranged in solid sheets, nests and cords interconnect by vessels of varying size. The tumor cells were round to oval, showed moderate nuclear pleomorphism, eosinophilic cytoplasm, atypical mitoses (>5/10HPF), and necrosis. Immunohistochemically tumor cells reveal diffuse and strong cytoplasmic positivity with smooth muscle actin (SMA). Based on histomorphology and immunohistochemistry, a final diagnosis of malignant glomus tumor was made. We report this case due to its rarity, and it to be included among the differential if the lesion is painful and recurrent.

Effectuation to Cognize malignancy risk and accuracy of fine needle aspiration cytology in salivary gland using "Milan System for Reporting Salivary Gland Cytopathology": A 2 years retrospective study in academic institution

Background

To accost things in a particular disciple, egress related to Fine Needle Aspiration Cytology (FNAC) and to standardize reporting pattern, a framework "Milan System for Reporting Salivary Gland Cytopathology" (MSRSGC) has been sponsored.

Aim

Aim of this study was to evaluate the potency of salivary gland FNAC reported under Milan guidelines, to calculate malignancy risk, and to compare the preoperative cytological diagnoses with the postoperative histopathological diagnoses.

Settings and Design

This was a retrospective study over a period of 2 years (May 2016 to April 2018), which was classified according to Milan system and correlation with histopathology. Furthermore, the risk of malignancy was calculated for all the diagnostic categories.

Materials and Methods

FNAC were analyzed on 105 patients with palpable salivary gland. Results were distributed into six categories. About 76 cases were surgically treated and resected tissues were submitted for histopathological examination.

Statistical Analysis

The various diagnostic values of the procedure were calculated using the standard formula.

Results

We reviewed 105 salivary gland FNA samples and recorded interpretations according to the proposed standardized six categories. Among them, category IV (neoplastic) had more cases (57.14%). The rates of malignancy in histology were as follows: (1) nondiagnostic, 0.0%; (2) nonneoplastic, 0.0%; (3) atypia of undermined significance, 50.00%; (4a) benign, 02.44%; (4b) uncertain malignant potential, 33.33%; (5) suspicious for malignancy, 100%; and (6) malignancy, 93.33%. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of Milan system came out to be 85.00%, 98.14%, 94.44%, 94.64%, and 94.59%, respectively.

Conclusion

The six-tier diagnostic categories of the Milan system helps in triaging patients with salivary gland swelling and thus facilitate individualized management.

Ectopic breast tissue lesion in axilla: Cytology report of two cases

Ectopic breast tissue (EBT) predominantly seen along the primitive embryonic milk lines that extend from axilla to groin. Axillary breast tissue is one of the common variant of EBT seen in 2% to 6% of women. Phyllodes tumour in EBT is uncommon. The various cystic, inflammatory and neoplastic lesions may occur in EBT similar to breast counterpart. Therefore, EBT should be carefully investigated as it may affect the management of the patient. We report two cases (axillary phyllodes tumour and axillary fibroadenoma) of axillary EBT diagnosed on cytology.

Fine-needle aspiration cytology of a cesarean scar endometriosis

Endometriosis is the presence of functioning endometrium outside the basement membrane of the uterine endometrium. It affects women of reproductive age and usually presents as a painful nodule over a period of 3 months to 10 years after surgery. Extrapelvic endometriosis is uncommon and more difficult to diagnose due to its variable presentation and is often confused with other surgical conditions. Fine-needle aspiration cytology (FNAC) is a rapid, cost-effective, and accurate diagnostic tool when making this diagnosis. Wide excision is the treatment of choice for scar endometriosis as well as for recurrent lesions. We present a case of scar endometriosis in a 30-year-old female who had undergone a cesarean section 2 years previously and was diagnosed by FNAC. A later histopathological examination confirmed the cytological diagnosis of scar endometriosis.

Study of adenotonsillectomy specimens: An institutional experience

Objective

Waldeyer's lymphatic ring consists of group of tonsils located over the posterior oropharyngeal wall. The palatine tonsils are largest tonsil. The present study was aimed to evaluate the significance of lymphoid hyperplasia, lymphocyte infiltration with and without defect in the surface epithelium in chronic tonsillitis (CT) and chronic adenotonsillar hypertrophy (CAH) in resected tonsillectomy and adenotonsillectomy specimens.

Materials and Methods

A total of 85 patients were included in the study. Fifty-one cases underwent bilateral tonsillectomy and 34 cases underwent adenotonsillectomy.

Results

The lymphoid hyperplasia was higher in CAH (30/34; 88.24%) as compared to CT (26/50; 52%). Lymphocyte infiltration with or without defect in the surface epithelium was common in CT. The histopathologic criteria of lymphoid hyperplasia and lymphocyte infiltration with or without defect in the surface epithelium showed a statistically significant difference between CT and CAH.

Conclusion

CT and CAH may be differentiated on the basis of reliable histopathological criteria. Punch biopsy can be performed to avoid CT complication if the clinical diagnosis is true. Choristomas can be clinically confused with true neoplasms, if large in size.

Acute abdomen with a misleading clinical entity

Massive ovarian edema is a rare, non-neoplastic solid tumor-like lesion. It results from compromised venous and lymphatic drainage due to partial or intermittent torsion of ovarian pedicle. Pain, distension or abdominal mass, menstrual irregularities, infertility and hormone-related symptoms can be the clinical presentation. We report a case of massive ovarian edema in a 28-year-old female who presented with acute pain abdomen. She was diagnosed clinico-radiologically with solid ovarian tumor and massive ovarian edema on histology. Massive ovarian edema should be suspected in female of reproductive age group presenting with abdominal pain, solid enlargement of ovary on radiology and normal serum tumor markers.

Epipalpebral conjunctival chondroid choristoma: Interesting developmental anomaly presenting in an adult

Ocular choristomas are uncommon lesions chiefly presenting in children. Choristomas may contain dermal and epidermal components, muscle, cartilage, bone, etc. They are usually seen in epibulbar conjunctiva, but epipalpebral location is uncommon. We present a case of epipalpebral chondroid choristoma presenting in an adult patient.

Pregnancy Luteoma in Ectopic Pregnancy: A Case Report

BACKGROUND

Pregnancy luteoma is a rare non neoplastic condition of the ovary. It is usually asymptomatic and found incidentally during imaging in pregnancy or during cesarean section. Pregnancy luteoma can also occur after ectopic pregnancy.

CASE PRESENTATION

A 30 year old female presented to G.B. Pant Hospital, Andaman and Nicobar Islands institute of Medical Sciences, Port Blair in October 2015 with abdominal pain. After initial investigations, exploratory laporotomy was done for ruptured ectopic pregnancy. Enlarged ovary was removed along with the ruptured portion of fallopian tube. Histopathological examination revealed solid aggregates of large cells with abundant eosinophilic cytoplasm; diagnosis of pregnancy luteoma was given.

CONCLUSION

It must be considered in the differential diagnosis of ovarian masses in pregnant females that early diagnosis of this entity may avoid unnecessary radical surgery.

Epidermal Cysts: A Clinicopathological Analysis with Emphasis on Unusual Findings

BACKGROUND

Epidermoid cysts, one of the common benign intradermal or subcutaneous tumors commonly result from the trauma to the pilosebaceous unit in the hair bearing area. In areas without hair, these cysts are considered implantation and proliferation of squamous epithelium into the dermis due to injury.

AIMS

The aim is to evaluate the clinicopathological details with emphasis on unusual findings related to epidermoid cysts.

STUDY DESIGN

This is a retrospective cross-sectional study carried out over 2 years.

MATERIALS AND METHODS

A total of 103 cases of epidermoid cysts were included in the study. The clinical details such as age, gender, sites, and dimensions were noted. The histopathological findings were evaluated and correlated with the clinical findings.

RESULTS

The highest incidence was observed in the age group of 21-30 years (23.3%, 24/103) and the most common affected region was the head and neck region (32%, 33/103). The size of cysts ranged from 0.3 to 9 cm in diameter with a mean of 2.1 cm. The unusual sites observed in this study were four at the left sole, two at right sole, two at prepuce, and one each at the right finger, left palm, and oral cavity. Histopathological findings included rupture of epidermoid cysts with giant cell reaction, melanin pigmentation, and association with other pathologies such as keloid and lipoma.

CONCLUSION

Epidermoid cysts are common benign intradermal or subcutaneous tumors, but they can have unusual presentations and histopathological findings. Epidermoid cysts need early diagnosis and treatment as they can cause cosmetic and functional impairment.

The Prevalence of Transfusion Transmitted Infections in ABO Blood Groups and Rh Type System

Screening of blood and blood products is important to reduce the risk of transfusion transmitted infections (TTIs). The transfusion of unscreened or inadequately screened blood and blood products are the major source of TTIs. The aim of this paper is to find out the prevalence of TTIs in ABO blood groups and Rh type system. A total of 4128 blood donors were screened from January 2010 to April 2014. Serological tests were performed for hepatitis B surface antigen (HBsAg), anti hepatitis C virus (Anti-HCV), anti HIV-1 and 2, venereal disease research Laboratory test (VDRL) and malaria parasite (MP) antigen. In seroreactive donors, HBsAg, Anti-HCV, VDRL, MP antigen and anti HIV were positive in 40 cases, 26 cases, 19 cases, 6 cases and 2 cases, respectively. Highest percentage of HBsAg, Anti HCV, VDRL, MP antigen and anti HIV was observed in blood group A negative (2/50), O negative (1/66), B negative (1/91), AB positive (2/377) blood group respectively. In the present study, the total number of Rhnegative donors is lower when compared to Rh-positive blood donors, but Rh-negative blood donors show higher percentages of seroreactivity for TTIs. Larger scale studies at molecular level are required to improve the knowledge of this aspect.

Fine-needle aspiration cytology of pilomatrixoma: A short series of three cases

Pilomatrixoma (PMX) (pilomatricoma, calcifying epithelioma of Malherbe) is a benign tumor with differentiation toward the hair matrix cells and is common in head and neck region. It is most commonly seen in the first two decades of life and presents as a subcutaneous, small, asymptomatic firm solitary nodule. Fine-needle aspiration cytology (FNAC) has been described as an important preoperative diagnostic investigation though on cytology the diagnosis of PMX is sometimes difficult and misdiagnosed. We describe two patients with gradually increasing asymptomatic swelling on pinna and middle finger. FNAC was done and a diagnosis of PMX was given, further confirmed by histopathological examination. The present cases highlight the importance of FNAC in considering PMX as differential diagnosis of dermal or subcutaneous nodules in locations other than head and neck. Cytopathologists who play an important role in the preliminary diagnosis should keep in mind the variability of the cellular composition of these types of lesions to avoid misdiagnosis.

A retrospective study of clinico-pathological spectrum of carcinoma breast in a West Delhi, India

BACKGROUND

Data on the demographic profile of breast cancer patients from Delhi is scarce and whatever is available is from higher referral center. Our hospital caters to patients from an urban population of the lower socioeconomic strata and is a representation of cases at a tertiary care hospital in west Delhi. In Delhi, breast cancer (26.8%) is commonest cancer among the female followed by cervix (12.5%), gallbladder (7.2%), ovary (7.1%), and uterus (3.3%).

AIMS AND OBJECTIVES

A retrospective audit of breast cancer patients presenting at a tertiary referral center from 2004 to 2011.

MATERIALS AND METHODS

A total of 328 cases diagnosed as carcinoma breast on histopathology from year 2004 to 2011 were retrieved and studied retrospectively with regards to demographic profile and their histological features with estrogen receptor (ER), progesterone receptor (PR), and Her2neu status.

RESULTS

The median age of presentation was 49 years of age. Infiltrating ductal carcinoma (IDC, not otherwise specified (NOS)) was the commonest histopathological variant (81.40%) followed by medullary carcinoma (10.36%) and mucinous carcinoma (2.74%). Triple negative were found to be the commonest group comprising 39.4% of all the cases followed by ER and PR both positive. Pathological tumor, node, and metastasis (TNM) staging showed most common group was T2N0M0 (19.5%) followed by T2N1M0 (17.1%) and T2N2M0 (14%).

CONCLUSION

The incidence of breast cancer in the India and include a higher incidence of ER, PR, and Her2neu negative disease in west Delhi.

Virilizing ovarian fibrothecoma with minor sex cord elements in a 13 year old girl: a rare case

Fibrothecoma accounts for 3-4% of all ovarian neoplasms; it is usually hormonally inactive, but can be estrogenic or sometimes androgenic (11%); it is rare under 30 years. In a very few cases, minor sex cord elements (less than 10% of the tumor area) are present; therefore, it is considered as a separate subgroup of stromal tumors. The importance of immunohistochemistry in recognizing this kind of tumor has been fully documented, with variable results on inhibin staining, but specific positivity for calretenin in such cases. We report here the rare case of a 13-year-old child with ovarian fibrothecoma and minor sex cord stromal elements, who showed negativity for inhibin and positivity for calretenin.

Diagnosis of a Nonpalpable Intraductal Papilloma without Radiological Abnormality by Nipple Discharge Smear Examination: A Case Report

Nipple discharge is the third most common breast complaint after breast pain and breast mass, most commonly associated with endocrine alterations and/or medications, pregnancy, lactation, post lactation, fibrocystic disease, intraductal papilloma, duct ectasia, nipple adenoma, infection, chronic mastitis, subareolar abscess, and least frequently, breast carcinoma. Cytological examination of nipple discharge (ND) is a noninvasive method of diagnosing the underlying breast pathology. We report a 46 year old female, who presented with pain and blood-mixed ND from the right breast with an impalpable mass. Cytological examination of the discharge was done and diagnosis of papillary neoplasm with degeneration, metaplasia, and atypia was given, which was further confirmed on histology and positive IHC for HMWCK and p63. Final diagnosis was intraductal papilloma of the lactiferous duct with squamous metaplasia and infarction. Differentiating benign papilloma from a carcinoma is challenging to the cytopathologist and requires clinicopathological correlation and a good knowledge of cytology.

Small cell extraskeletal osteosarcoma: a rare case report

Extraskeletal osteosarcoma is a rare malignant mesenchymal neoplasm and its small cell variant is one among the rarest variant. This article describes a 60-year-old woman presenting with a large, lobulated, painful mass in left thigh with associated history of trauma since 18 months. Her magnetic resonance imaging showed a variegated mixed intensity lesion with associated cystic degeneration, necrosis and matrix arborizing nearby muscles. Fine needle aspiration cytology showed a small cell lesion with very scant osteoid. Tumor was excised and histopathological diagnosis was small cell osteosarcoma involving adjacent muscles and fat with sparing of lymph nodes. The aim of this article is to present the clinical, radiological, cyto-histological and immunohistochemical features of this extremely rare lesion.

Endodermal sinus tumor of vagina in infants

Endodermal sinus tumor (or Yolk Sac tumor) of the vagina is a rare malignant germcell tumor which is seen exclusively in children younger than 3 years of age. We report two cases of endodermal sinus tumor of the vagina. In both cases no radiological investigation was done and serum alpha-fetoprotein was elevated. The histopathological examination of both the tumor masses revealed vaginal endodermal sinus tumor. Periodic-acid-Schiff stain with diastase showed diastase resistant hyaline globules. These findings confirmed the diagnosis of endodermal sinus tumor in both cases. Vaginal endodermal sinus tumor is both locally aggressive and capable of metastasis. The serum alpha-fetoprotein level is a useful marker for diagnosis and monitoring the recurrence of vaginal endodermal sinus tumor in infants. Early detection and therapy is important because of its aggressive nature and good response to chemotherapy.

A glomus tumour arising from the flexor aspect of the forearm: a case report with review of the literature

A 45 year old male patient presented with the complaint of a purplish nodular painful swelling on the flexor aspect of the left forearm of five years duration. A radiological examination of the lesion was not done prior to its excision. A biopsy was done and it was sent for a histopathological examination. The biopsied tissue was single, irregular, firm and globular, it measured 0.5 x 0.5cm in size and it was processed in two halves Its microscopic examination showed a well circumscribed area which comprised of sheets and nodules of monomorphic round cells with slightly vesicular, round nuclei and an acidophilic cytoplasm, amongst which were interspersed numerous blood vessels, many of which were dilated and congested, along with numerous lymphatic channels which were filled with lymph. Immunohistochemistry for SMA, CEA and CD 34 was advised, out of which only SMA turned out to be strongly positive and a final diagnosis of a Glomus tumour was made.

Aleukemic granulocytic sarcoma presenting at multiple sites: ovary, breast and soft tissue

An 18 year old female presented with the history of pain in abdomen, breast engorgement, swelling over both legs and breathlessness for three month. On clinical examination diagnosis of fibroadenoma breast was made. Ultrasonography of abdomen showed bilateral ovarian mass. Bilateral salpingo-ophrectomy was done and specimen was sent for histological examination. Two lobulated solid masses of tissues the larger one measuring 13×8×5 cm and smaller one measuring 10×7×5 cm in size received. Microscopic examination showed monomorphic population of discohesive, hyperchromatic small round cells had high N:C ratio, coarse chromatin, conspicuous nucleoli and scant to moderate amount of basophilic cytoplasm, lying in sheets and separated by fibrous strands and diffusely infiltrating the ovarian stroma. Fine needle aspiration from breast lump and leg swelling showed predominant population of blast cells. Myeloperoxidase was strongly positive and diagnosis of granulocytic sarcoma was confirmed.