nan Anshu

Pleomorphic lobular carcinoma of the breast: A case report

BACKGROUND Pleomorphic lobular carcinoma of the breast is associated with aggressive behavior. CASE Fine needle aspiration cytology was performed on a breast lump in a 55-year-old woman. The aspirates showed highly pleomorphic, large cells in a dyscohesive pattern, with a tendency of few cells to aggregate in small groups. A diagnosis of ductal carcinoma was made on cytology. On histology, the paraffin sections showed features of pleomorphic lobular carcinoma of the breast. CONCLUSION The cytologic features of pleomorphic lobular carcinoma overlap with those of infiltrating ductal carcinoma. It is very difficult to make a diagnosis of pleomorphic lobular carcinoma prospectively on cytology. However, if Indian file arrangement and cytoplasmic vacuolation are present, pleomorphic lobular carcinoma must at least be suggested for the differential diagnosis as it has different clinical implications.

Role of modified bleach method in staining of acid-fast bacilli in lymph node aspirates.

OBJECTIVE To correlate acid-fast bacilli (AFB) positivity with cytomorphologic patterns of tuberculous lymphadenitis and evaluate bleach concentration method in diagnosing lymph node tuberculosis compared to Ziehl-Neelsen (ZN) method. STUDY DESIGN One hundred cases of tuberculous lymphadenitis diagnosed by fine needle aspiration cytology (FNAC) were analyzed and classified into 6 cytomorphologic patterns and correlated with bacillary load using routine and modified bleach methods of ZN staining. Smears were graded for AFB positivity. Sensitivity of routine ZN and modified bleach concentration was compared. RESULTS The classic cytomorphologic pattern of tuberculosis showing epithelioid granulomas, Langerhans giant cells and caseous necrosis was seen in 23% of cases. Routine ZN staining detected AFB in 27% of cases and the modified bleach method in 72%. In 58 cases the modified bleach method had a higher grade of AFB positivity than the routine method. The modified bleach method did not miss any AFB positivity detected on routine ZN staining. CONCLUSION The modified bleach method demonstrated AFB positivity in 72% of cases. AFB positivity grade was much higher than with routine ZN staining, making bacilli easily visible, with shorter screening time. The modified bleach method is inexpensive, easily performed and more sensitive and safe than routine ZN staining.

Cytodiagnosis of eumycotic mycetoma: a case report.

BACKGROUND Mycetoma is a late-stage clinical manifestation of a subcutaneous infection produced by bacteria (actinomycetoma) or fungi (eumycetoma). Only a few articles have described the morphologic appearance of this uncommon pathology on cytology. The distinction between eumycetoma and actinomycetoma in fine needle aspiration cytology (FNAC) is as accurate as in histopathology, as demonstrated in the present case. CASE A 30-year-old man presented with a large swelling on his left foot with a discharging sinus. FNAC of the swelling yielded pus-like material. Initial Papanicolaou and Giemsa stains showed the presence of septate, branching fungal hyphae and black granules against the inflammatory background. The presence of fungus was confirmed by PAS stain. The species was identified as Exophiala jeanselmei on fungal culture. CONCLUSION Mycotic mycetoma can be accurately diagnosed by FNAC, which is a simple, inexpensive and rapid technique when there is a high index of suspicion. Special stains and culture studies are helpful in confirmation of diagnosis and species identification.

Spectrum of male breast lesions diagnosed by fine needle aspiration cytology: A 5-year experience at a tertiary care rural hospital in central India

This study examines the spectrum of lesions in the male breast at a tertiary care rural hospital in central India and explores the role of Fine Needle Aspiration Cytology (FNAC) in the diagnosis of these lesions.

Cytodiagnosis of hepatic amyloidosis by fine needle aspiration cytology : A case report

BACKGROUND Amyloid in fine needle aspirates tends to be overlooked due to its rarity. It may appear at virtually any site and can be identified by special stains. CASE In a case of amyloidosis of the liver, where fine needle aspiration cytology was instrumental in making the primary diagnosis. Smears revealed normal hepatocytes and chronic inflammatory cells. Amorphous material (amyloid) was extensively present between compressed hepatocytic clusters. It stained pale green in Papanicolaou-stained preparations and reddish purple with Giemsa stain. This material was initially thought to be hyalinized granulomas. However, it was later confirmed to be amyloid by using Congo Red stain. CONCLUSION Whenever amorphous material is present in smears, a high index of suspicion for amyloid needs to be maintained.

Sclerosing stromal tumor of the ovary.

Sclerosing stromal tumor is a rare ovarian tumor, occurring in young adults in the second and third decade of life. We report clinical and histopathological features of three cases of sclerosing stromal tumor of the ovary with a review of literature. The tumor has distinct histological features and is easily recognizable when a high index of suspicion is maintained in young patients presenting with an ovarian mass. These tumors are benign and can be treated successfully by enucleation or unilateral ovariotomy.

Cytodiagnosis of erythema nodosum leprosum. A case report.

BACKGROUND The application of cytology in leprosy has been restricted to the evaluation of morphologic and bacterial indices by slit skin smears to facilitate diagnosis of cases according to the Ridley-Jopling scale. Isolated reports have now documented the use of fine needle aspiration cytology (FNAC) in the diagnosis of leprosy. CASE A 45-year-old male presented with the abrupt onset of multiple nodular eruptions all over the body. The clinical diagnosis was Sweets syndrome. FNAC showed numerous neutrophils in a background of foamy macrophages. Special stains revealed the presence of a large number of fragmented acid-fast bacilli in the smears. A diagnosis of erythema nodosum leprosum (ENL) was made on FNAC. CONCLUSION The presence of neutrophils in a characteristic milieu of foamy macrophages is seen in lesions of ENL. Such a picture should prompt the cytologist to use a modified Ziehl-Neelsen stain to demonstrate acid-fast bacilli, as ENL can present as an acute episode in patients without a previous diagnosis of leprosy.

Metaplastic carcinoma of the breast in an HIV-positive patient: A case report

BACKGROUND Metaplastic carcinoma of the breast is a rare neoplasm that causes diagnostic difficulty on fine needle aspiration smears. Breast carcinoma in HIV-infected patients occurs at a relatively early age, with increased bilateral disease, unusual histology, and early metastatic spread with a poor outcome. CASE A case of metaplastic carcinoma of the breast arose in a 36-year-old woman who was seropositive for HIV. In the absence of a sarcomatous component and presence of obvious ductal differentiation on aspirates, a diagnosis of high grade infiltrating duct carcinoma, not otherwise specified, was made on fine needle aspiration cytology (FNAC). CONCLUSION This case underlines the limitations of FNAC in the diagnosis of metaplastic carcinoma of the breast. It also shows that it is imperative to maintain a high index of suspicion for rare pathologies in immunocompromised patients.

Prevalence and Risk Factors for Patient Delay Among Women With Breast Cancer in Rural India.

Delay in seeking health care by women with breast cancer increases mortality risk. This study was conducted in rural India to identify risk factors associated with patient delay. A total of 212 women with primary breast cancer diagnosed between 2010 and 2012 were interviewed. Sociodemographic characteristics, time interval between seeking medical attention and appearance of symptoms, and reasons for delay were inquired. Patient delay was defined as more than 3 months between date of first symptoms and medical consultation. Logistic regression was applied to assess associations between potential risk factors and patient delay. Almost half the women with breast cancer experienced patient delay. Age more than 60 years (odds ratio = 4.9, 95% confidence interval = 1.3-18.0) was significantly associated with patient delay. Only 6.6% of patients had heard about breast self-examination. Significantly higher number of patients with delay presented with advanced clinical stage (P = .000). Health education programs should be introduced with specific strategies to shorten patient delay.

Cytodiagnosis of granulocytic sarcoma of liver arising in a milieu of myeloid metaplasia: a case report.

BACKGROUND Granulocytic sarcoma is an extramedullary tumor that is composed of granulocytic precursor cells. We report an unusual case of granulocytic sarcoma of the liver that arose in the background of myeloid metaplasia. Fine needle aspiration cytology (FNAC) was instrumental in making the diagnosis in absence of previously known Hematlogic abnormality. CASE A 65-year-old woman presented with multiple nodules in the liver. USG-guided FNAC was performed on them. The aspirates showed many myeloid blasts, myelocytes, metamyelocytes, erytbroid precursors and lympboglandular bodies. We considered a differential diagnosis of granulocytic sarcoma and myeloid metaplasia. The presence of erytbroid precursors prompted us to consider myeloid metaplasia as a differential diagnorsis of granulocytic sarcoma. Peripberal smear showed a leukoerytbroblastic reaction. The patient died, and necropsy from the liver revealed extensive infiltration by undfferentiated blast cells with areas of myeloid metaplasia showing maturing erytbroid, myeloid and megakaryocytic elements. CONCLUSION When a dual population of predominant myeloid blasts and normoblarts is encountered, a suspicion of granulocytic sarcoma arising in a background of myeloid metaplasia must be kept. Cells of all 3 lineages may not be always seen in myeloid metaplasia, and 1 cell line may predominate, causing a diagnostic dilemma.