Anne Wilkinson

FNAC in the diagnosis of lymph node malignancies: A simple and sensitive tool

Context: Fine needle aspiration cytology (FNAC) of the lymph node is a simple diagnostic tool to diagnose suspected and unsuspected secondary and primary lymph node malignancy. Aim: To study the utility of FNAC in the diagnosis of clinically suspected and unsuspected lymph node malignancy. Design: A cross-sectional hospital based study on 50 patients diagnosed to have primary or secondary lymph node malignancy by cytology, and confirmed by histopathology. Materials and Methods: Lymph node aspirate smears reported as malignant were studied and the findings were correlated with histopathology. Clinical and radiological data were also noted. Statistical Analysis: The data were tabulated as per the involvement of the various lymph node groups and the types of secondary and primary lymph node malignancies involved. Results: 45 cases of metastatic malignancy and five cases of lymphomas were diagnosed by FNAC of lymph nodes. Histopathological correlation was available in all cases. Malignancy was clinically unsuspected in nine cases (18%). Conclusion: FNAC of lymph nodes is a very useful, simple and sometimes the only tool in the diagnosis of lymph node malignancies.

Villous Adenoma of the Appendix with Dysplasia

Sir, A 35-year-old male patient reported to the surgeon with complaints of repeated attacks of pain in abdomen, associated with nausea and vomiting. He had clinical evidence of acute appendicitis. The patient was operated and an appendicectomy was done. The specimen was sent for histopathological examination. Grossly, the appendix measured 6 × 1.2 × 1 cm and showed a bulbous, globular and enlarged tip. The cut section showed localized thickened wall at the tip. Microscopic examination revealed mucosa with villous and papillary infoldings, mostly covered by a single layer of tall columnar mucous-producing cells [Figures ​[Figures11 and ​and2].2]. Stratification was seen in some areas. At places, mild dysplastic change was also seen in the basal half of the mucosa. Mucous secretion was present, but without distension of the lumen of appendix. The remaining layers showed presence of acute inflammation. These findings were mainly seen in the sections taken from the tip of the appendix. The base of the appendix (surgical margin) was normal. Based on the histopathological findings, a diagnosis of villous adenoma of appendix with mild dysplasia and acute appendicitis was made. Figure 1 Photomicrograph showing part of wall of appendix with inflammation and villous configuration of the mucosa (Haematoxylin and eosin, ×10) Figure 2 Photomicrograph of the epithelium of appendix showing villous configuration lined by mucus-producing cells (Haematoxylin and eosin, ×40) Appendiceal tumors account for less than 0.4% of neoplasms in the gastrointestinal tract and are found in less than 1% of appendectomies.[1,2] Adenoma of the appendix is a rare pathological entity, which may progress to invasive carcinoma. They rarely produce clinical symptoms, and are mostly discovered incidentally during histopathological examination. A few may present with acute appendicitis.[1,3] Villous adenoma of the appendix is a rare pathological condition.[4,5] Adenomas of the appendixes, like adenomas elsewhere in the large intestine, are neoplastic lesions, which may progress to invasive adenocarcinoma,[3] and, once diagnosed, indicates a need for further investigation due to an association with neoplasia elsewhere.[6] Appendiceal adenomas are diffuse villous lesions involving large areas of the appendiceal mucosa. They frequently have a villous configuration with papillary fronds covered by large number of mucus-producing cells, which often have a deceptively innocuous appearance. The dysplastic nature of the lesion is best appreciated by examining the epithelial characteristics in the basal half of the mucosa, where crowding and stratification of the cells with nuclear atypia will be appreciated. Areas with a serrated pattern may be seen. Excessive mucous production by the lining epithelial cells may occur, in which case a mucocoele of the appendix may form.[3] Adenomas of the appendix may be cured by appendicectomy,[1,3] provided the resection line at the base of the appendix is tumor-free. Careful scrutiny of the remainder of the large intestine is necessary in patients with appendiceal adenomas because of the strong association with synchronous or metachronous colorectal adenomas and carcinomas.[3] Our patient has been asymptomatic for the last 2 years.

Inflammatory Myofibroblastic Tumour of Lung, Masquerading As Tuberculosis – A Case Report

Inflammatory myofibroblastic tumor is a histologically distinctive lesion that occurs primarily in the viscera and soft tissue of children and young adults. It is considered a tumor of borderline malignancy because of its tendency to recur locally (at least at certain sites) and its ability to metastasize rarely. It is composed of a variable mixture of collagen, inflammatory cells, and usually cytologically bland spindle cells showing myofibroblastic differentiation. There are many uncertainties about the pathogenesis of IMT. Currently, surgery is the mainstay of the treatment for IMTs. It has three histological subtypes. The differential diagnosis of this lesion depends on the clinicopathologic setting, including the patient’s age, gender, tumor location, and number of lesions. Rarely inflammatory myofibroblastic tumors have a conspicuous population of large multinucleated tumor cells with prominent nucleoli bearing a resemblance to the Reed-Sternberg cells of Hodgkin’s disease. Based on the two largest studies of abdominal and retroperitoneal lesions, it is clear that tumors in this location have a propensity for more aggressive behavior than their extra-abdominal counterparts, with recurrence rates of 23% to 37%.

Aspergillus Salpingitis: A Rare Case Report

We describe the pathology of a unique case of fallopian tube aspergillosis in a 45 year old woman. She complained of lower abdominal pain and lump in lower abdomen since 2-3 months. Clinically she was diagnosed as benign ovarian tumor, right ovary. Pathological examination showed dilated fallopian tube containing yellow material. Microscopic examination showed Aspergillous filaments surrounded by dense infiltrate of neutrophils and lymphocytes. Even though Aspergillous salpingitis is a rare entity, the correct diagnosis is of great importance for the indication of proper therapy.