Ashis Kumar Saha

Impact of image guided fine needle aspiration cytology in diagnosis of pediatric hepatic mass and cytohistologic concordance

Background: Pediatric hepatic mass is a heterogeneous group of benign and malignant lesions. Percutaneous fine needle aspiration cytology (FNAC) can be utilized as a diagnostic modality to assess the nature of radiologically demonstrated hepatic lesions and thus facilitate individualized treatment. Aims and Objective: The objective of the present study was to determine the diagnostic accuracy of percutaneous FNAC of pediatric liver masses, a procedure that is less invasive than open biopsy. Materials and Methods: A prospective, observational study was carried out in the Department of Pathology in collaboration with Department of Pediatric surgery and Radio-diagnosis including 31 pediatric patients presenting over last two years (June 2011 to May 2013) with focal hepatic lesion on ultrasound and computed tomography (CT) scan. FNAC was carried out under image guidance and cytodiagnosis was reached after appropriate staining. By comparing with histopathology reports, diagnostic accuracy of cytology was evaluated. Result: Among 31 cases included in the study, 51.6% cases were cytologically benign and hemangioma was the most common benign lesion. Hepatoblastoma was the most accounted malignant tumour (12.9%). FNAC provided 94% sensitivity and 92% specificity in diagnosing benign and malignant tumours. Overall diagnostic accuracy was 93.10%. No significant complication was noted. Conclusion: Percutaneous FNAC under image guidance is an effective diagnostic tool for diagnosis of primary and metastatic tumours of liver in pediatric patients.

FNAC Versus Core Needle Biopsy: A Comparative Study in Evaluation of Palpable Breast Lump

INTRODUCTION Breast carcinoma is the most common malignant tumour and the leading cause of carcinoma death in women in world. The main purpose of FNAC or CNB of breast lumps is to confirm cancer preoperatively and to avoid unnecessary surgery in specific benign conditions. AIMS AND OBJECTIVE The objective of the study was to compare between Fine Needle Aspiration Cytology (FNAC) and Core Needle Biopsy (CNB) in the diagnosis of breast carcinoma with final histological diagnosis from excision specimen as it is gold standard. MATERIALS AND METHODS A prospective study was done on 50 cases. Patients undergoing all three procedures (Fine Needle Aspiration Cytology and Core Needle Biopsy done at Department of Pathology; subsequent excision surgeries done at Department of General Surgery) were selected. May Grunwald Giemsa (MGG) and Papaniculou (PAP) staining were performed on cytology smears. Haematoxylin and Eosin (H&E) staining was done on both the CNB and tissue specimens obtained from subsequent excision surgeries to see the histological features. RESULTS FNAC showed sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 69%, 100%, 100%, 38.1%, and 74% respectively in diagnosing carcinoma. CNB had sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 88.3%, 100%, 100%, 53.3% and 86%. Both FNAC and CNB showed statistically significant correlation with confirmatory HPE of excision specimen (p-value <0.05) in the diagnosis of breast carcinoma. CONCLUSION Fine needle aspiration cytology (FNAC) is a rapid, less complicated, economical, reliable and relevant method for the preoperative pathological diagnosis of breast carcinoma in a developing nation like ours. If the initial FNAC is inadequate, core needle biopsy (CNB) can be a useful second line method of pathological diagnosis in order to minimize the chance of missed diagnosis of breast cancer.

Correlation of cytohistlogical expression and serum level of ca125 in ovarian neoplasm.

UNLABELLED Context or Background: CA125 is a biomarker that has potential utility across the spectrum: risk assessment, early detection, diagnosis, prognosis, monitoring and therapy. AIMS AND OBJECTIVES This study was conducted to establish the validity and reliability of correlation of CA125 serum level with immunochemistry expression in imprint cytology and tissues for diagnostic purpose. MATERIALS AND METHODS A prospective study was done on 50 cases of clinically and radiologically diagnosed ovarian tumor. Imprint smears were made intraoperatively from fresh samples and stained with M.G.G. stain for air dried smears and Papanicoloau stain for alcohol fixed smears. Stained smear was assessed and compared with subsequent histopathology report. Preoperative blood samples were obtained from all patients and sent for the assay of serum CA125 levels. Analysis of CA125 immunochemistry expression in imprint cytology and tissue was done and correlated with preoperative serum blood CA125 levels. RESULTS Significant positive correlation was found between elevated serum CA125 levels and cytohistological expression of CA125. Overall sensitivity was 100%, specificity was 86%, positive predictive value was 74% and negative predictive value 100%. Diagnostic accuracy was 90% with high statistical significance (p<0.001). CONCLUSION We considered 35 U/mL as the cut-off value when evaluating serum CA125 ovarian cancer. Patients with high serum levels show good cytohistological expression.

Critical clinical appraisal of the role of computed tomography-guided minimally invasive aspiration cytology in evaluation of retroperitoneal masses.

Context: Fine-needle aspiration (FNA) is increasing in popularity as a means of diagnosing mass lesions in retroperitoneal area. With use of radiologic guidance for needle placement, this technique is an effective way to obtain diagnostic material. Aims: The aims of the study were (1) to establish the validity and reliability of fine needle aspiration cytology in preoperative diagnosis of retroperitoneal tumor, and (2) to compare the significance of cytological diagnosis with histopathological report. Settings and Design: A prospective, cross-sectional hospital-based study. Materials and Methods: A prospective, cross-sectional study was designed on 45 cases of clinically and radiologically diagnosed retroperitoneal tumor in a tertiary care hospital. Computerized tomography (CT)-guided percutaneous FNA was performed and cytology smears were stained with May-Grünwald-Giemsa stain and conventional Papanicolaou (Pap) stain. Smears were broadly categorized into unsatisfactory, benign, suspicious of malignancy and malignant lesion. The cytological diagnosis was compared with subsequent histopathology report. Statistical Analysis: Positive and negative predictive values, diagnostic accuracy, chi-square test and others. Results: The total number of cases studied was 45, which include both epithelial tumors and mesenchymal tumors. Age group varied from 15 to 70 years. The overall sensitivity in our study to diagnose benign and malignant tumors by FNA cytology is 86% and the specificity is 96% with positive and negative predictive value of 86% and 96%, respectively. Diagnostic accuracy was 93.55% with high statistical significance (P < 0.001). Conclusions: FNA cytology is a simple, fast, reliable and less expensive method for diagnosis of various retroperitoneal neoplasms.

A Case of Lateral Neck Cyst with Ectopic Thyroid Papillary Carcinoma

Thyroid develops from median rudiment which is a surface elevation dorsal to the tuberculam impar and forms by proliferation of endodermal cells. Lateral thyroid element of the fourth pouch contributes in the development of thyroid gland. Failure of the lateral thyroid element to fuse with the median element may result in a lateral ectopic thyroid gland. In the present case, patient initially presented with lateral neck cyst. There were two possibilities in the patient: a) a cystic degeneration of lymph node metastasis from an occult thyroid papillary carcinoma and b) thyroid papillary carcinoma arising from ectopic thyroid tissue within a branchial cleft cyst. Histological examination demonstrated foci of normal thyroid glands along with evidence of papillary thyroid carcinoma. These finding favours the possibility of malignant transformation of follicular epithelial cells of ectopic thyroid tissue within a branchial cleft cyst. There was a focus of papillary thyroid carcinoma in the resected total thyroidectomy specimen. So differentiation between two possibilities becomes difficult in this patient. A papillary thyroid carcinoma found with a cyst of the lateral neck represents a diagnostic and therapeutic dilemma.

Fatal anaphylaxis following multiple red fire ant strings

Red Fire Ants Are Present In Almost All Countries And In All Places. Because Of Their Resistance To Natural And Chemical Control, Fire Ants Can Overwhelm Their Environment And Destroy Land And Animals. Fire Ants Can Also Cause A Variety Of Health Problems In Humans, Ranging From Simple Stings To Severe Life Threatening Anaphylaxis. Most Of The Deaths Following Red Fire Ant Strings Are Reported From South-Eastern United States And Australia. We Report A Three-Year-Old Child, Known Allergic To Ant-Venom, Who Died From Severe Anaphylactic Reactions Following Multiple Red Fire Ant Strings (Solenopsis Geminata). This Type Of Presentation Following Red Fire Ant Strings Is Probably First Time Reported From India. Beside Clinical Diagnosis, Significance Of Laboratory Investigations Including Postmortem Examinations In Fatal Anaphylaxis Is Also Discussed Here.

A Cytohistological Correlation in Ovarian Tumours

The present study was conducted to assess whether imprint cytology can help in rapid diagnosis of ovarian neoplasm and thus facilitate individualized treatment. Aims of our study were to establish the validity and reliability of Imprint cytology in intraoperative diagnosis of ovarian tumour and to compare the significance of cytological diagnosis with histopathological report. Ours is an Institution base prospective study designed on 50 cases of clinically and radiologically diagnosed ovarian tumour at the Dept of pathology IPGME&R, Kolkata which is a tertiary care referral hospital. Imprint smears were made intraoperatively from fresh samples and stained with M.G.G. stain for air dried smears and Papanicolaou stain for alcohol fixed smears. Stained smear was examined under light microscope and cytological findings were noted. Tissue for histopathological study was obtained in the form of post operative material. The previous cytological findings were compared with subsequent histopathology report. Out of total 50 cases, 32(64%) was epithelial tumours and 18(36%) non-epithelial tumour cases. Age group varied from 5 to 62 years. Overall sensitivity in our study to diagnose benign and malignant ovarian tumours by imprint cytology is 94% and the specificity is 74% with positive and negative predictive value of 63% and 96% respectively. Diagnostic accuracy was 78% with high statistical significance (p<0.001). Hence we conclude that imprint cytology is a less expensive, simple, fast and reliable method for diagnosis of various ovarian neoplasms.

A Very Rare Case Of Primary Renal Hydatidosis

Primary Kidney involvement in echinococcosis is extremely rare. We present a rare case of primary left renal hydatid with gross hydatiduria with history of short haematuria. We diagnosed the case from the typical clinical history of intermittent passage of small, white, balloon-like, grape-sized structures in the urine for the last one month. On radiological imaging, USG abdomen revealed multiseptate cyst in the left kidney; liver was normal. The CT scan revealed a cystic lesion in the left kidney. Left nephroureterectomy was done by flank extraperitoneal approach and diagnosis was confirmed post operatively by the gross appearance and microscopy. Kidney involvement in echinococcosis is extremely rare, constituting only 2-3% of all cases. Primary involvement of the kidney without the involvement of the liver and lungs is even rarer. Hydatiduria accompanies only 10-20% of all cases of renal hydatidosis and is usually microscopic. We present a rare case of primary left renal hydatid with gross hydatiduria. The diagnosis of primary hydatid cyst of the kidney, in the absence of hydatiduria, is usually radiological as most patients have negative immunological tests. We also present the salient radiological features of primary hydatid cyst of kidney. II. CASE REPORT A 25-year-old male presented with history of intermittent passage of small, white, balloon-like, grape-sized structures in the urine for the last one month. He also had intermittent haematuria for 15 days. Abdominal examination did not reveal any palpable lump. Rest of the systemic examination was normal. His routine blood investigations were normal with no eosinophilia and normal renal function tests. X- ray chest P-A view was normal. The USG abdomen revealed multiseptate cyst in the left kidney; liver was normal. The CT scan revealed a cystic lesion in the left kidney.

Evaluation of Changes in Serum Sodium and Potassium Following Ileostomy and Colostomy

Maintenance of normal fluid-electrolyte balance is desirable for maintenance of homeostasis. Much is now known about the metabolism of sodium and potassium and their effects on the body when these electrolytes are deficient. Their loss through skin, kidney and bowel has been studied. But less is known about their excretion through artificially created stoma of the bowel. Further not much work was done in this respect in this rural part of the West Bengal with extreme climate and great swing in temperature dryness. This compounds the problem of such patients due to increase losses of fluid and electrolytes through the skin and lungs. In our study we estimated serum electrolytes, namely serum sodium and serum potassium post operatively at 24hrs (1 st post operative day), 72 hrs (3 rd post operative day) and 120 hrs (5 th post operative day) during the post operative study period, no patient expired and all the patients resuscitated adequately in pre operative period, and maintained an adequate urine output. All the patients in this study had their stoma created on operation for emergency condition. We concluded that patients having high output ileostomy (≥1000ml/day), there was a significant decrease in serum sodium and serum potassium on 5 th post operative day. And we recommend that all patients who undergo ileal resection along with ileostomy, or who have high ileostomy output, should be closely monitored for electrolyte derangement from the 3 rd post operative day

Adult Intussusceptions: A Series of 5 Cases

Intussusception in adult patients is rare in comparison to paediatric patients. We are hereby reporting a series of five cases of adult intussusception. In most of the cases, USG findings were diagnostic and organic lesions were found as causative factors but the diagnosis of intussusceptions from any cause in pregnancy is made more difficult by the common overlapping complaints of nausea, vomiting and abdominal pain, which may persist during the second trimester. The very low incidence rate of 1/30,000 of all hospital admissions makes it far more difficult to diagnose. A very much vigilant mind can only reduce the morbidity out of this condition by use of meticulous Ultrasonography Key wards: intussusception, Ileo-caecal, colo-colic,