Arghya Bandyopadhyay

USG guided FNAC of ovarian mass lesions: A cyto-histopathological correlation, with emphasis on its role in pre-operative management guidelines

OBJECTIVE Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of ovarian masses is an efficient diagnostic modality for accurately diagnosing ovarian tumours prior to surgery. The main aim of this study was to assess the sensitivity, specificity and accuracy of FNAC in diagnosing ovarian masses. MATERIAL AND METHODS Eighty-three patients with ovarian masses were recruited and correlation of USG-guided FNAC was made with histopathology in all but 6 cases, where surgery was not indicated. RESULTS Cytological diagnosis was obtained in all 83 ovarian lesions: 56 cases were benign, 6 possibly benign, 3 suspicious of malignancy and 18 cases as malignant. Out of 77 cases where histology was available, the 12 non-neoplastic cysts were endometriotic cysts and follicular cysts. The majority of neoplastic lesions were surface epithelial tumours. Out of 12 non-neoplastic cysts and 43 benign tumours, all but two were diagnosed as benign or possibly benign on cytology; of the 22 histologically malignant or borderline tumours, 18 were malignant or suspicious of malignancy on cytology, while four were false negative (three of these were borderline tumours). Thus, the sensitivity of cytological diagnosis was 83%, specificity was 97% and accuracy was 93%. CONCLUSION USG-guided FNAC seems to be a relatively safe, simple, fast and cost-effective procedure where most ovarian malignancies either present late in their course or no screening method is available. In addition, cyto-radiological correlation through this procedure may be useful in deciding management guidelines prior to any surgical intervention.

Post-kala-azar dermal leishmaniasis developing in miltefosine-treated visceral leishmaniasis

Post-kala-azar dermal leishmaniasis (PKDL) is an unusual dermatosis occurring following an attack of visceral leishmaniasis (VL). There are only few reports of PKDL after successful treatment with miltefosine. We report two cases of PKDL that developed after successful treatment of VL with miltefosine.

Primary bilateral small lymphocytic lymphoma of ocular adnexal origin: Imprint cytology suggests the intraoperative diagnosis

Ocular adnexal lymphomas (OAL) involve the peri-global soft tissues like orbit, eyelid, conjunctiva, lacrimal gland. We describe a rare case of primary bilateral OAL, histomorphologically small lymphocytic lymphoma, B cell phenotype of lacrimal gland origin. Rapid intraoperative diagnosis can be suggested on imprint cytology; subsequent histology and immunohistochemistry are helpful for confirmation and further line of management. Since no preformed lymphoid structures are expected within the orbit or lacrimal gland, any lymphoid mass here should be critically evaluated as a lymphoproliferative lesion.

Cutaneous Chromoblastomycosis Mimicking Tuberculosis Verrucosa Cutis: Look for Copper Pennies!

Abstract Chromoblastomycosis is a rare chronic fungal infection of skin and subcutaneous tissue. It is primarily a disease of tropical and subtropical regions and affects mainly the agricultural workers following trauma with vegetable matter. Cutaneous Chromoblastomycosis may clinically mimic cutaneous tuberculosis as both the condition usually presents with hyper pigmented verrucous lesion of skin. Here in we report a case of chronic cutaneous Chromoblastomycosis in a middle aged woman from north eastern part of India, who was initially misdiagnosed as Tuberculosis verrucosa cutis. In histopathology characteristic brown colored spores of the fungus (also known as copper pennies) were seen within dermal abscess. The organism isolated from culture of the biopsy material was Fonsecaea pedrosoi thus confirming our diagnosis of cutaneous chromoblastomycosis. The patient responded well to oral Itraconazole. The dermatologists and pathologists should be aware of this condition especially when dealing with verrucous lesion of the skin. The pathologists should search for fungal spores in cutaneous lesion with pseudoepitheliomatous hyperplasia and dermal abscess. Öz Kromoblastomikoz, deri ve subkutan yumuşak dokunun nadir kronik mantar enfeksiyonudur. Öncelikle tropikal ve subtropikal bölgelerdeki tarım işçilerinde bitkilerle oluşan travma sonrası gelişir. Kutanöz kromoblastomikoz, her ikisinde de görülen hiperpigmente verrüköz deri lezyonları nedeniyle, klinik olarak deri tüberkülozunu taklit eder. Bu makalede, Hindistan’ın kuzeydoğu bölümünde yaşayan ve başlangıçta tüberkülozis verrükoza kutis yanlış tanısı alan kronik kutanöz kromoblastomikozlu orta yaşlı bir kadın hasta sunulmuştur. Histopatolojik olarak dermal abseler içinde “bakır metelik” olarak da bilinen karakteristik kahverengi mantar sporları görüldü. Biyopsi materyalinden hazırlanan kültürde Fonsecaea pedrosoi izole edildi ve kutanöz kromoblastomikoz tanımız doğrulandı. Olgu, oral Itraconazol tedavisine iyi yanıt verdi. Dermatolog ve patologların derinin verrüköz lezyonlarını değerlendirirken uyanık olması, özellikle psödoepitelyomatöz hiperplazi ve dermal abse içeren lezyonlarda patologların mantar sporlarını özenle araması gereklidir.

A rare case of chondromyxoid fibroma mimicking spina ventosa

Chondromyxoid fibroma (CMF) is perhaps the rarest of all bone tumors. Classically it occurs in the metaphyseal region of the long bones surrounding the knee. The small bones of the feet are also commonly involved. But CMF occurring in small bones of the hand, however, is very uncommon. Tuberculous dactylitis is referred to as spina ventosa. The bones of the hands are more frequently affected than bones of the feet. We present a rare case of CMF occurring in the middle phalanx of the left middle finger which was misdiagnosed as spina ventosa clinicoradiologically. It can be a common mistake especially in areas where prevalence of tuberculosis is still high. This case once again stresses the need for biopsy and to consider CMF as a rare differential diagnosis in all suspected cases of spina ventosa.

Cytopathological dilemma of anaplastic sacral chordoma with radiological and histological corroboration.

Chordoma is a relatively rare locally invasive and potentially malignant tumor of fetal notochord origin, affecting the axial skeleton. Cytopathological diagnosis of chordoma is favored by the presence of characteristic physaliphorous cells, bearing abundant foamy cytoplasm dispersed in a myxoid matrix. Anaplastic chordoma or dedifferentiated chordoma, an even rarer variant, can cause a diagnostic confusion with chondrosarcoma from the cytopathological point of view, with similar chondromyxoid matrix and atypical cells. Hence, chordoma bearing anaplastic features needs to be identified and should be distinguished from chondrosarcoma on aspiration cytopathology. We present a case of anaplastic sacral chordoma in a man 59 years of age, causing extensive destruction of sacrum and invading the paravertebral tissues as evidenced by radiology. Fine needle aspiration cytopathology revealed few large pleomorphic hyperchromatic cells, admixed with characteristic physaliphorous cells and myxoid matrix. The cytopathological diagnosis has been confirmed by histopathology and immunohistochemistry. Since anaplastic chordoma bears an unfavorable prognosis, it should be suspected on preoperative aspiration cytopathology. Clinicoradiological correlation along with histopathological and immunohistochemical confirmation is necessary subsequently.

Juvenile xanthogranuloma-diagnostic challenge on fine-needle aspiration cytology

Juvenile xanthogranuloma (JXG) is a rare cutaneous lesion with paucity of literature on its cytological features. We report one such case which on fine-needle aspiration cytology yielded a mixed population of foamy histiocytes, multinucleated giant cells and variable admixture of lymphocytes and eosinophils causing diagnostic dilemma with other differentials, especially Langerhans cell histiocytosis. However, clinical correlation followed by histopathology confirmed the diagnosis. Hence, JXG has characteristic and diagnostic cytologic features.

Secondary Signet Ring Cell Carcinoma of Prostate

True metastases to prostate from solid tumors are reported only in 0.2% of all surgical prostatic specimens and 2.9% of all male postmortems. Clinical context, morphological features, and immunohistochemical localization of prostate specific antigen (PSA) are supposed to clarify the differential diagnosis between a secondary and a primary tumor. We report an unusual and rare case of secondary signet ring cell carcinoma (SRCC) of prostate in which the clinical data and signet ring cell morphology pointed toward the diagnosis of a primary SRCC. Immunohistochemistry (IHC) for PSA not only proved the case to be a secondary SRCC but also initiated the process for diagnosis of the occult primary malignancy in the patient′s stomach.