Annals of Pathology and Laboratory Medicine

Fine Needle Aspiration Cytology of Granulomatous Lesions of The Breast

Bhavna Nayal — 2020-03-11

Background: Granulomatous lesions of the breast are uncommon and can mimic malignancy. Fine needle aspiration (FNA) is among the first investigations in such patients. Cytological diagnosis in the absence of granulomas may pose a diagnostic dilemma. The present study outlines the cytological features of such lesions.

Methods: This was a 6-year (January 2011 and December 2016) retrospective study. Cases with a biopsy proven diagnoses of granulomatous mastitis having FNA of the corresponding lesion were included in the study. Clinical, radiological and microbiological details were retrieved from the medical records. The cytology slides were reviewed and correlated with clinical and histopathological findings.

Result: Thirty-two cases were included in the study. The age range was 22 to 62 years. On cytology, 17 showed well-formed granulomas. One case each of Mycobacterium tuberculosis and Burkholderia pseudomallei were identified by culture. Among the 15 cases with no granulomas, scattered histiocytes and giant cells were seen. Most patients presented with breast lump and fever. Uncommon presentations included peau de orange, skin erythema, induration, nipple retraction and axillary lymphadenopathy. Most lesions were hypoechoic on mammography. Nine cases were clinically suspicious for malignancy while rest were diagnosed as abscess, fibroadenoma or mastitis.

Conclusion: In the developing world, tuberculosis and meliodosis can present with granuloma formation. In the breast, these entities can have overlapping features with idiopathic granulomatous mastitis. In the absence of granulomas on cytology, these lesions may be mislabeled as breast abscess. In such cases, the presence of scattered histiocytes and giant cells may aid in diagnosing these lesions.

Implication of Serum and Salivary Levels of Albumin as a Diagnostic Tool in Oral Premalignancy and Malignancy

Riti Tushar Kanti Sinha — 2020-03-11

Background: Reactive oxygen and nitrogen species are involved in the initiation and promotion of the multistep carcinogenesis. In neoplastic conditions many biochemical substances many biochemical substances including albumin show altered values .The aim of the present study was to investigate whether serum and salivary albumin levels can be used as diagnostic tools in oral premalignant and malignant leisons.

Methods: The study includes a total of 45 subjects with 15 each of normal healthy, pre-malignancy and malignancy. Five milliliter of venous blood was drawn and unstimulated saliva was collected in the early morning. Albumin levels were estimated by Bromocresol Green Method.

Results: Serum albumin levels were found to decrease in pre-malignancy and malignancy as compared to healthy individuals. Salivary Albumin levels were increased in pre-malignancy and malignancy as compared to healthy individuals.

Conclusion: Tobacco consumption is one of the most important risk factors for the development of oral cancer. Burst of reactive oxygen species which cause oxidative stress in tobacco users is prime form of damage brought to the genetic material leading to non-lethal mutations causing pre-malignancy and malignancy. Serum protein has long been implicated to have anti-oxidant properties due to rich concentration of free thiol group. Albumin is a potent extracellular anti oxidant defense and a reliable marker of oxidative stress in the body. It could be helpful in the early identification of various oral pre malignancy and malignant leisons.

Cyto-Histological Evaluation of Bronchial Brushing, Bronchial Washing and Bronchial Biopsy in Lung Tumours

Jigyasu Joshi — 2020-03-11

Background: Lung cancer is the most frequently diagnosed major cancer in the world with a high mortality rate because most of the cases are diagnosed in advanced stage therefore early diagnosis of lung cancer is crucial in management. Examination of specimens obtained through flexible fiberoptic bronchoscope is an important and often the initial diagnostic technique performed in patients with suspected lung carcinoma. A study on cyto histological evaluation of bronchoscopic procedure samples was carried out to find out the efficacy of the procedures in lung tumours in southern Rajasthan.

Methods: Bronchoscopy was performed in total 100 patients with clinico- radiological suspicion of lung cancer. Bronchial brushing, washing and biopsy were taken wherever possible. Cytology and biopsy samples processed and slides prepared for examination.

Result: Overall sensitivity and specificity of bronchial brushing was 85.3% and 56.25% while for wash/BAL (bronchoalveolar lavage) the values were 78.34% and 59.26% respectively. Bronchial brushing had higher sensitivity for central as well as peripheral tumours while wash/BAL had higher sensitivity as well as specificity for peripheral tumours.

Conclusion: Bronchial brushing and wash/BAL has excellent sensitivity and good specificity and yields almost same information as biopsy. But regarding histological typing of lesions, biopsy is more effective than cytological study. Therefore, all these techniques may be used concurrently to diagnose the lung tumours.

Diagnostic Implication of Mean Platelet Volume in Thrombocytopenia

Archana Bhat — 2020-03-11

Introduction: The newer haematology analysers measure the platelet indices such as the mean platelet volume (MPV), platelet large cell ratio and platelet distribution width. It has been observed that MPV is increased in conditions associated with thrombocytopenia due to peripheral destruction.

This study was carried out to know the utility of MPV and derive cut-off values in categorizing the conditions causing thrombocytopenia into hyperdestructive and hypoproliferative groups.

Methods: The thrombocytopenia cases were categorized into two groups as hyperdestructive and hypoproliferative groups based on the bone marrow findings. The MPV on the day of admission was taken into consideration. The data were analysed using the mean, standard deviation and the t-test. ROC curve was plotted to derive the cut-off MPV value.

Results: Of the total 89 thrombocytopenia cases, 53 were of hyperdestructive etiology and 36 were of hypoproliferative etiology. The mean MPV for group A was 9.56 with a standard deviation of 1.34 and that for group B was 8.45 with a standard deviation of 1.30. The p value was < 0.001. From the ROC curve, a cut off of 8.5 fl was taken.

Conclusion: We conclude that a MPV value of >8.5fl is suggestive of a hyperdestructive etiology. Even though bone marrow remains a gold standard to distinguish between the hyperdestructive and hypoproductive thrombocytopenia groups, platelet indices like MPV can be used to aid in the diagnosis of etiology of thrombocytopenia.

Cytomorphological Study of Thyroid Nodule and Categorization According to The Bethesda System and Its Histopathological Correlation

Nikita Rupareliya — 2020-03-12

Background: Among an endocrine disorder, thyroid disorders are most commonly encountered disorder in routine clinical practice. Clinically it is quite difficult to evaluate thyroid lesion and reach clinical diagnosis. FNAC (Fine needle aspiration cytology) of thyroid is commonly performed and most effective tool for diagnosis and management of patient with thyroid nodule. Present study was conducted in department of pathology, government medical college, Surat. Our main aims and objectives are to report thyroid cytology smears by TBSRTC in to various diagnostic categories and to correlate these with histopathological findings.

Material and method: In the present study FNAC was performed on total 250 cases that were presented with thyroid swelling. These cases categorized according to TBSRTC and cytological diagnosis was correlated histopathologically in total 21 cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated.

Results: FNAC was carried out in 250 cases, diagnostic categories includes 5.20% non-diagnostic, 87.60% benign, 2.80% Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance, 2.40% follicular neoplasm or suspicious for follicular neoplasm, 1.60% suspicious for malignancy and 0.40% malignant lesions. Subsequent histopathological correlation was possible in 21 cases. In present study accuracy, sensitivity, specificity, positive predictive value and negative predictive value of FNAC in diagnosis of thyroid were 95%, 85.71%, 100%, 100% and 92.85% respectively.

Conclusion: Standardized categorical Bethesda systems for reporting thyroid FNAC can make results easier to understand and interpret for clinicians and give clear indications for therapeutic action.

Hormone Receptor Status and KI67 Proliferation Index in Meningiomas

Rajeshwari B — 2020-03-12

Background: Meningiomas are the most common extra-axial tumours of central nervous system arising from arachnoidal cap cells. The biological behaviour of these tumours is unpredictable because of the tendency of these tumours to recur irrespective of the grade. However, WHO grading is the most useful morphological predictor of recurrence. Additional prognostic parameters like Ki67 proliferation index and progesterone receptor status are useful in predicting the risk of recurrence. This study was undertaken to evaluate the spectrum of Ki67 proliferation index in various grades of meningiomas and to correlate these findings with the hormone receptor status.

Methods: In this study 225 cases of meningiomas, over 6 yrs period, were studied which included grade 1 and grade 2 meningiomas. The relation between Grade, Ki67 proliferation index and progesterone receptor status was studied.

Result: We found a significant positive correlation between grade and Ki67 proliferation index at 0.01 level and significant negative correlation between Grade and progesterone receptor status at 0.05 level. There was also significant negative correlation between progesterone receptor status and Ki67 proliferation index in cases with progesterone receptor staining score of 6 to 12. Many of the grade 1 meningiomas also showed a higher Ki67 proliferation index

Conclusion: In this study we conclude that, PR and Ki67 Proliferation index are useful supplements of routine histopathological assessment of meningiomas and can be used as prognostic indicators regarding behavior and response to treatment.

A Study of Variation in Adult Thrombocytopenic Histograms

Archana Shetty — 2020-03-12

Background: With the advent of automation in hematology, both platelet indices and their histograms are available from the blood cell counters at no extra cost or time. The variations of histograms in various mechanisms of thrombocytopenias are explored in this study.

Methods: Adults with thrombocytopenia determined with (name of the analyser) were categorized into four groups based on the mechanism of thrombocytopenia and variations in platelet histograms were studied in all groups. Data was collated and analysed using Excel.

Results: A total of 224 adults with thrombocytopenia were seen, most of them had hyperdestructive type (73.6%) followed by hypoproductive type (16.08%), abnormal pooling (6.3%) and EDTA induced thrombocytopenia (4.01%). The following variations in histogram were seen; Normal curve (8.03%), Curve not touching/reaching the baseline (43.75%), Broad based curve (10.71%), Bimodal curve (7.14%), Curve with short peak (25.9%) and Saw-tooth appearance of curve (4.47%) and correlated with the above mentioned mechanisms of thrombocytopenias using SPSS software version 20.

Conclusion: An awareness regarding the variations in the platelet curve ensures a good correlation with its numerical parameters and also with the etiology of thrombocytopenias. With the era of automation taking over in most of the laboratories, it is imperative to have knowledge about these simple yet, often overlooked platelet histograms.

Cytological Study of Tuberculosis in Pulmonary and Extrapulmonary Lesions in Correlation with Cartridge Based Nucleic Acid Amplification Test (CBNAAT)

Gayathri Dronadula — 2020-03-12

Introduction: Various methods can be used for the detection of tuberculosis of which microscopy, culture and identification of the organism's DNA are known. Newly introduced Nucleic acid amplification test (NAAT) if used in combination with other tests provide improved diagnostic yield.

Aims and Objectives: To diagnose tuberculosis bacilli in various cytological samples and sputum samples. To evaluate the diagnostic efficacy of combined approach of conventional smear study and and CBNAAT.

Material and Methods: A Total of 50 cytology samples received in Pathology Department were studied over a period of 6 months. These included sputum (20), lymph node(22),body fluids(8).For these samples routine staining and ziehl neelsen are done and the remaining sample is sent for CBNAAT.Results are compared among AFB,CBNAAT for these samples. Sensitivity and specificity of microscopy and CBNAAT tests were calculated.

Results: Out of 50 cases 31 cases were positive for smear study and 29 cases were positive for CBNAAT.

Conclusion: Cytological examination of TB in association with CBNAAT is more confirmatory, sensitive and specific tool for the early diagnosis of MTB in variety of clinical samples.

Multicentric Invasive Pleomorphic Lobular Carcinoma of Breast

Sunil V Jagtap — 2020-03-07

Invasive Pleomorphic Lobular Carcinoma is a very rare histopathological variant of breast cancer. It constitutes less than 1% of invasive breast carcinoma .We present a 70 year female presented with lump in right breast of 10 months duration. The lump was insidious in onset, progressive in nature and was associated with gradual skin color changes. Patient was a known diabetic and was on regular treatment. On fine needle aspiration cytology showed positive for carcinoma cells. Right modified mastectomy was performed. On histopathology reported as Invasive Pleomorphic Lobular Carcinoma – Grade II with multicentric nodules. Right axillary lymph nodes with perinodal infiltration of tumor were noted.

We are presenting this case for its uncommon type, clinical, histomorphological and immunohistochemistry pattern.

Isolated Intracranial Rosai Dorfman Disease

Ritika Singh — 2020-03-07

Rosai-Dorfman Disease (RDD) is an idiopathic lymphohisticyocytic disorder characterized clinically by massive painless cervical lymphadenopathy, fever and weight loss. Extranodal involvement has been recognized. Central nervous system (CNS) manifestations are rare. Intracranial localization of the disease without involvement of other sites is very rare and needs to be differentiated from various mimicking lesions especially meningioma. A radiological and histological confirmation followed by complete resection of the lesion is the treatment of choice.

Synchronous Mucinous Tubular and Spindle Cell Carcinoma of the Kidney and Papillary Carcinoma of the Thyroid

Gwendolyn Fernandes — 2020-03-07

A 55 year old female, presented with flank pain and fullness since 2 years. On examination, a 10x10cm, ballotable lump was present in the right flank. CT Abdomen showed a 9.5x8.8 cm, exophytic mass lesion in the right kidney with patchy arterial enhancement and heterogenous enhancement in the venous phase. Whole body PET CT showed well defined, metabolically active masses in the right kidney, thyroid and cervical lymph nodes. Nephrectomy specimen received, showed a tumor measuring 12x7x6.5 cm creamy-white, fleshy, replacing the kidney. Histopathology revealed an unusual renal neoplasm with tubule formation merging with bland spindle cells and a focal myxoid stroma. Tumor cells were immunoreactive for CK7, EMA, vimentin and were negative for PAX8, CD10 & AMACR. The diagnosis of Mucinous Tubular and Spindle cell carcinoma (MTSCC) was established. FNAC of the thyroid nodules showed a classic papillary thyroid carcinoma.

Incidental Prostate Carcinoma Diagnosed at Radical Cystoprostatectomy for Bladder Carcinoma

Sonal Paul — 2020-03-12

Introduction: The incidence of concomitant urothelial carcinoma of the bladder and adenocarcinoma of the prostate varies from 17% to 70% as per various literature studies.

Case report: We report the case of 82 year old male who presented with hematuria and lower urinary tract symptoms. A cystoscopy was performed which was suggestive of a 6x4x5cm mass arising from the left anterolateral wall and dome of the bladder. A Transurethral biopsy of the bladder mass showed a high grade papillary urothelial carcinoma invading the muscularis propria. Following this, the patient underwent a radical cystoprostatectomy. Histopathological examination of the bladder mass confirmed High -grade urothelial carcinoma. The entire prostate was sampled which revealed Adenocarcinoma prostate, Gleason score 3+4=7, tumor volume 6cc.

Conclusion: The incidence of incidentally detected prostatic adenocarcinoma in Carcinoma bladder cases is extremely variable. Complete sampling of the prostate helps in detecting these lesions.

Rare Neurogenic Tumor - Pacinian Neurofibroma

Shivani Panhotra — 2020-03-12

Pacinian neurofibroma (PN), a rare benign dermal tumor characterized by proliferation of pacinian corpuscles in the dermal myxoid stroma. A 50 year female presented with slow growing, soft, painless swelling over right wrist. No other significant history was found. Histopathology revealed proliferation of fibrous connective tissue along with whorled structures. No cellular atypia was found. Immunohistochemistry examination with antibodies against protein S-100 showed diffuse positivity. A diagnosis of Pacinian neurofibroma was made.

Coexistence of Granulomas and Metastatic Breast Carcinoma Deposit in an Axillary Lymph Node

Akanksha Bhatia — 2020-03-12