Chayanika Pantola

Congenital granular cell tumor of the alveolar ridge.

Congenital epulis or neonatal granular cell tumor is a tumor whose histogenesis has long been debated. It is dissimilar to other granular cell tumors; the latter having derivation from Schwann cells and hence being S-100 positive. We report a case of congenital granular cell tumor in a newborn female child that was uneventfully operated. The case is reported here because of its rarity.

Microfilaria in cytological smears at rare sites coexisting with unusual pathology: A series of seven cases.

Filariasis is a major public health problem in India and microfilaria is sometimes seen during routine fine needle aspiration cytology (FNAC) smears, but it is very rare to find microfilaria coexistent with neoplastic lesions. Here we report a series of seven cases in which microfilaria is associated with neoplastic lesions. Out of these seven cases one is benign and six are malignant. Also we first time report the microfilaria coexistent with parotid pleomorphic adenoma, undifferentiated carcinoma thyroid and gall bladder carcinoma.

Cytological diagnosis of pediatric thyroid nodule in perspective of the Bethesda System for Reporting Thyroid Cytopathology

Background: Thyroid nodule is one of the most common endocrinopathies occurring children and adolescents. Though thyroid nodule is rare in the pediatric age group, the rate of malignancy is much higher in this age group compared to adult population. Aim: The objective is to study the application of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric patients and compare the findings with histology. Materials and Methods: A total of 218 cases younger than 18 years were studied in a 4-year period from August 2010 to July 2014. The smears were categorized according to TBSRTC into six categories — Nondiagnostic, benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), suspicious for follicular neoplasm (SFN), suspicious for malignancy (SM), and malignancy. Results: Out of 218 cases, 33 were males and 185 were females. Histological follow-up was available in 44 cases. The diagnosis according to TBSRTC included 12 (5.5%) nondiagnostic, 151 (69.26%) benign, 23 (10.5%) AUS/FLUS, 18 (8.2%) SFN, 5 (2.3%) SM, and 9 (4.1%) malignancy cases. On histological follow-up, the rate of malignancy in each category was 0%, 0%, 8.3%, 10% 100%, and 100%, respectively. Conclusion: The study demonstrates that TBSRTC in pediatric thyroid nodule is as sensitive and specific as in adults, especially with 100% accuracy in the diagnosis of benign and malignant categories.

Tuberculosis Verrucosa Cutis Developing Over A Keloid: A Rare Presentation

Cutaneous tuberculosis can present as either primary or secondary infection, or it can be associated with systemic tuberculosis. It can present with unusual clinical and histological features causing delay in diagnosis and treatment. Tuberculosis verrucosa cutis occurs as a single verrucous lesion over exposed areas of the body along with inflammatory borders and discharging sinus. Here, we are presenting a rare case of tuberculosis verrucosa cutis developing over a keloid. There is no report of such case in literature so far.

Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: A cytological dilemma

Sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) of the thyroid is a rare primary thyroid tumor arising in a background of Hashimoto′s/lymphocytic thyroiditis and has been recently introduced in the World Health Organization (WHO) classification of thyroid tumors. It is characterized by extensive sclerosis, squamous and glandular differentiation, and inflammatory infiltrate rich in eosinophil. Here, we are discussing the cytological features of this rare case in a 35-year-old female presented with thyroid swelling and lymph-node enlargement.

Polarized fluorescence study in human cervical tissue: change in autofluorescence through different excitation wavelengths

This study aims towards applying the intrinsic fluorescence technique, extracted from polarized fluorescence, to detect subtle biochemical changes occurring during the progression of cancer from human cervical tissue samples. The efficacy of this technique, earlier validated through tissue phantoms, is tested in human cervical tissues by comparing the biochemical changes for diagnostic purpose at different wavelengths. It is pertinent to note that the co and crosspolarized fluorescence do not display the high sensitivity obtained through extracted intrinsic fluorescence. We observed that sensitivity and specificity of intrinsic fluorescence technique is high at 325 and 370nm for Collagen and NADH respectively in comparison to 350nm excitation wavelength. It may be concluded that decoupled information at 325 and 370nm wavelengths for collagen and NADH respectively, through intrinsic fluorescence provides better diagnostic parameter for early detection of cervical dysplasia. This information can provide a guiding path for designing a probe for clinical purpose.

Intrinsic fluorescence for cervical precancer detection using polarized light based in-house fabricated portable device

Abstract. An in-house fabricated portable device has been tested to detect cervical precancer through the intrinsic fluorescence from human cervix of the whole uterus in a clinical setting. A previously validated technique based on simultaneously acquired polarized fluorescence and polarized elastic scattering spectra from a turbid medium is used to extract the intrinsic fluorescence. Using a diode laser at 405 nm, intrinsic fluorescence of flavin adenine dinucleotide, which is the dominant fluorophore and other contributing fluorophores in the epithelium of cervical tissue, has been extracted. Different grades of cervical precancer (cervical intraepithelial neoplasia; CIN) have been discriminated using principal component analysis-based Mahalanobis distance and linear discriminant analysis. Normal, CIN I and CIN II samples have been discriminated from one another with high sensitivity and specificity at 95% confidence level. This ex vivo study with cervix of whole uterus samples immediately after hysterectomy in a clinical environment indicates that the in-house fabricated portable device has the potential to be used as a screening tool for in vivo precancer detection using intrinsic fluorescence.

Effective Screening and Classification of Cervical Precancer Biopsy Imagery

Microscope images of biopsy samples of cervical precancers conventionally discriminated by histopathology, the current “gold standard” for cancer detection, showed that their correlation properties are segregated into different classes. The correlation domains clearly indicate increasing cellular clustering in different grades of precancer compared with their normal counterparts. This trend indicates the probability of pixel distribution of the corresponding tissue images. Because the cell density is not uniform in the higher grades, the skewness (asymmetry of a distribution), kurtosis (sharpness of a distribution), entropy (randomness), and standard deviation are affected. A combination of these parameters effectively improves the diagnosis and quantitatively classifies the normal and all the three grades of precancerous cervical tissue sections significantly. Thus, the statistical analysis of microscope images is a promising approach for early stage tumor detection and quantitative classification of precancerous grades; this can effectively supplement the qualitative analysis by the pathologist.

Study and Discrimination of Human Cervical Tissue Images through Multifractal Analysis

We report here a study of confocal microscope images to classify cervical precancers by a multifractal analysis. This study is performed using an inverted confocal microscope with laser scanning fluorescence imaging. The periodic structure of collagen present in the stromal region of cervical tissue gets disordered with progress in grade of dysplasia. This disorder is investigated through the β-exponent of a Discrete Fourier Transform (DFT) of the confocal images, enabling us to discriminate between the lowest and highest grades of dysplasia in human cervical tissue sections. The Holder exponent from 2D images further classifies various grades of dysplasia from normal tissue sections though Gd3 and Gd1 are indistinguishable. DFT however, clearly distinguishes Gd3 from Gd1. In addition to stromal images, epithelial images were also investigated for better classification. The cellular density of epithelium increases with depth for various grades of dysplasia and is not uniform. The Holder exponent, which measures multifractality, is higher for dysplastic tissue sections than for normal ones because of the above morphological differences. Extraction of subtle fluctuations from optical images through multifractal studies promise to be a powerful diagnostic technique.

Intrinsic fluorescence based in-vivo detection of cervical precancer with hand held prototype device

A prototype device (hand held probe) designed and fabricated in the lab has been tested for cervical precancer detection using intrinsic fluorescence. The intrinsic fluorescence gets strongly modulated by the interplay of scattering and absorption. This masks valuable biochemical information which is present in the intrinsic fluorescence. These distortion effects can be minimized by normalizing the polarized fluorescence spectra by the polarized elastic scattering spectra. The measurements have been made with a in-house fabricated device using a 405 nm diode laser and white light source respectively. 166 sites of different grades of cervical pre-cancer biopsy samples (CIN I and CIN II) (CIN: cervical intraepithelial neoplastic) have been discriminated from 29 sites of normal biopsy samples using principal component analysis (PCA) based linear discriminant analysis (LDA). The sensitivity and specificity for discrimination of normal samples from CIN I are found to be 99% and 96% respectively. Further the normal samples can be discriminated from CIN II samples with 96% sensitivity and 96% specificity. Based on these promising ex-vivo results an in-vivo study on patients has been initiated in the hospital. The hand held device built in-house shows promise as a useful tool for in vivo cervical precancer detection by polarized fluorescence. Preliminary in-vivo results on 10 patients indicate the efficacy of the hand held device for screening cervical precancers using intrinsic fluorescence.