Adarsh Barwad

Human papilloma virus associated head and neck cancer: A PCR based study.

Head and neck cancers (HNC), 90% of which are squamous cell carcinomas (SCC), rank sixth among all malignancies worldwide and comprise 40–50% of the total number of malignancies in India. In addition to alcohol and tobacco usage, which is the major source of oral carcinogens, viruses such as human papilloma virus (HPV) may also contribute to development of the malignancy. The aim of this study was to identify the prevalence of HPV in head and neck cancers using material from metastatic site.

Fine needle aspiration cytology of insular carcinoma of thyroid.

Poorly differentiated (insular) thyroid carcinoma is defined as a thyroglobulin‐producing non‐follicular non‐papillary thyroid carcinoma, having an intermediate behavior between well‐differentiated and anaplastic carcinomas. FNAC is widely used as aid for workup of thyroid gland lesion. However, scant information is available in the literature about cytologic findings of this rare entity.

Artificial neural network in diagnosis of metastatic carcinoma in effusion cytology

To build an artificial neural network (ANN) model for the detection of carcinoma in effusion cytology.

Prevalence of Human Papilloma Virus in Esophageal Carcinomas: A Polymerase Chain Reaction-Based Study

Objectives: Human papilloma virus (HPV) has been repeatedly found in esophageal carcinoma tissues. However, detection rates of HPV DNA in these tumors have varied markedly. Differences in detection methods, sample types and geographic regions of the sample origin have been suggested as potential causes of this discrepancy. This study was undertaken to analyze the prevalence of HPV in esophageal carcinoma. Study Design: HPV L1 DNA was evaluated in a total of 49 esophageal carcinoma samples, including 44 cases of squamous cell carcinoma (SCC) and 5 cases of adenocarcinoma. Seventeen control samples of esophageal brushings were also analyzed. The HPV L1 fragment was detected using MY09/MY11 primers. Results: In test samples, 17/49 (34.7%) were positive for HPV L1 and, in comparison, none of the control samples were positive. HPV DNA was identified in 17/37 (46%) cases of non-keratinizing SCC and was not identified in any case of esophageal keratinizing SCC and adenocarcinoma. Conclusion: This study defines a significant association of HPV with esophageal non-keratinizing SCC. Our findings raise the possibility that HPV is involved in esophageal carcinogenesis, especially the non-keratinizing type of SCC. Further investigation with a larger sample size over broader geographic areas may be warranted.

Fine needle aspiration cytology of epithelioid sarcoma.

In this case report, we have described the fine needle aspiration cytology (FNAC) of epithelioid sarcoma (ES) in a 40‐year‐old female patient who presented with multiple nodular swellings over right forearm and single right axillary lymph node. The FNAC smear showed predominantly dispersed as well as three‐dimensional clusters of malignant cells admixed with basement membrane like material. The individual cells were moderately pleomorphic with round to oval nuclei and moderate to abundant amount of cytoplasm. The neoplastic cells have well‐defined cytoplasmic borders and intercellular spaces. The excision biopsy of the swelling of the forearm showed ES. The cytology features of ES are characteristic and a preoperative diagnosis is helpful for proper management of the case. Diagn. Cytopathol. 2010.

Ameloblastic fibrosarcoma: A cytologist's perspective

Fine‐needle aspiration cytology of a case of ameloblastic fibrosarcoma (AFS), an unusual odontogenic tumor related to ameloblastoma (AB), was performed in a 25‐year‐old female with a 1 cm swelling in the left lower orbital region along with involvement of zygomatic region. Aspiration of the tumor yielded a cellular sample composed predominantly of mesenchymal element and few clusters representing epithelial component showing tall columnar cells with peripheral palisading. Detailed cytomorphological features of AFS are discussed along with differential diagnosis from other tumors such as AB, desmoplastic AB, odontogenic fibroma, ameloblastic fibrodentinoma and ameloblastic fibro‐odontoma, ameloblastic fibroma. Diagn. Cytopathol. 2011.

Hepatoblastoma—An attempt of histological subtyping on fine‐needle aspiration material

Hepatoblastoma (HB) is classified into epithelial, mixed (epithelial/mesenchymal), and small‐cell (anaplastic) type. Wnt/β‐catenin pathway plays a key role in hepatic development, regeneration, and tumorigenesis, and HB is known to present β‐catenin mutations (50–90%). The present study was undertaken to delineate the cytomorphologic features of HB and to evaluate the feasibility of subtyping of HB on fine‐needle aspiration cytology (FNAC). The expression of β‐catenin in these tumors was also evaluated both of histopathologic sections and on the aspirated material. Thirty‐three cases with fine‐needle aspirates of HB were retrieved over a period of 12 years. Cytologic diagnosis was reviewed in the light of clinicoradiological data, response to therapy, and subsequent histopathology. Immunochemistry for β‐catenin was performed in 19 of 33 cases on histopathologic sections (n = 10)/cell blocks (n = 6)/cytosmears (n = 3). Based on the cytologic features, the cases were divided into fetal HB (n = 17), embryonal HB (n = 4), combined epithelial HB (n = 8), and mixed HB (n = 4). Four cases of histopathologically proven mixed HB were reported as pure epithelial HB on FNAC, as mesenchymal elements were not represented in the cytology smears. Cytoplasmic as well as nuclear staining for β‐catenin was noted in a total of 10 of 19 cases. FNAC can accurately categorize epithelial HB; however, in mixed type, the accuracy depends on number of areas sampled. Cell block can be of help to perform ancillary investigations especially β‐catenin for both diagnostic and therapeutic purposes. Cytopathol. 2013.

Image cytometry of insular carcinoma.

To study the morphometric features of insular carcinoma (IC) of thyroid and follicular carcinoma (FC) in fine needle aspiration cytology (FNAC) smear to evaluate the role of the morphometric features to distinguish these two groups. We performed image morphometry in Hematoxyline and Eosin stained FNAC smears of eight each histopathology proven cases of IC and FC of thyroid. Nuclear area, diameter, perimeter, and standard deviation of nuclear area (SDNA) of these two groups were studied and compared. Nuclear area, diameter, perimeter, and SDNA of IC and FC were 30.43 μ2, 7.31 μ, 23.01 μ, 8.81 and 38.43 μ2, 7.66 μ, 25.63 μ, 10.83, respectively. Students t‐test analysis did not show any significant difference (P > 0.05) in these two groups. Nuclear morphometry data indicate that the nuclear size and shape of IC and FC are essentially similar and it is not possible to differentiate these two entities with the help of image morphometric data. Diagn. Cytopathol. 2012.

Primary leiomyosarcoma of the prostate with lung metastasis: Report of a case diagnosed by fine‐needle aspiration cytology

Prostate leiomyosarcoma is an extremely rare and highly aggressive neoplasm that accounts for less than 0.1% of primary prostate malignancies. Herein, we present a patient with primary leiomyosarcoma of the prostate with lung metastasis diagnosed primarily on fine‐needle aspiration cytology. Characteristic cytological features such as small fascicles of spindle cells with blunt‐ended nuclei, positivity for desmin and smooth muscle actin along with the radiological features are helpful in the correct diagnosis. Diagn. Cytopathol. 2010.

Metastatic of mature component in a treated case of immature teratoma diagnosed on fine-needle aspiration cytology of the liver.

Dear Dr. Bedrossian: Immature teratoma of the ovary is an uncommon tumor, comprising of <1% of teratomas of ovary. In contrast to the mature cystic teratoma, which occurs in reproductive age group, the immature teratoma occurs most commonly in first two decades of life. Immature teratomas are composed of tissue derived from the three germ layers and contain immature and embryonal structure. Immature teratoma grows rapidly, penetrates its capsule, and forms adhesion to surrounding structure. It metastasizes first to para aortic and pelvic lymph node and later to lung, liver, and other organ. Excision of tumors is often followed by local recurrence, usually within first year of primary therapy. Here, we present a case of immature teratoma that presented with isolated liver metastasis and was confirmed in FNAC from the liver as metastasis of mature elements. A 26-year female pregnant patient was referred to the department of gynecology in September 2009 at eighth month of gestation with left adenexal mass detected on ultrasonography. No other mass lesion was identified in other organs. Patient was subsequently managed with elective lower uterine cesarian section with the removal of left ovarian mass. Grossly, the tumor was well encapsulated. Cut surface showed solid as well as small cystic areas of maximum size 5-mm diameter. Histological sections showed a neoplasm composed of an admixture of mature and immature teratomatous elements. The immature elements were mainly in the form of neuroectodermal rosettes and tubules (Fig. 1). Rosettes were lined by small round basophilic cells with high-mitotic activity. Mature element was mainly composed of respiratory and intestinal epithelium. No other germ-cell components were identified despite extensive sampling. Based on histological findings and amount of immature element, diagnosis of immature teratoma grade 2 was given. Based on the diagnosis, patient was treated with postoperative chemotherapy with six cycles of bleomycin, etopoxide, and cisplatin (BEP) regimens. Three months after completion of chemotherapy, patient on follow-up presented with dull aching pain in right hypochondrium. On CT scan, single large subcapsular mass having fat density was identified in the segments 7 and 8 of right lobe of liver measuring 10 3 9.5 3 7.8 cm (Fig. 2). On ultrasonography examination, the lesion showed heterogeneous intensity with predominantly solid areas. Standard FNAC procedure was performed under ultrasonography guidance. Three passes were taken from different areas of the lesion. The cytological diagnosis of metastatic teratoma with mature elements was given in FNAC.