Farhan Asif Siddiqui

Sonographic assessment of cervical lymphadenopathy: Role of high‐resolution and color Doppler imaging

The objective of this article was to study the role of high frequency ultrasound and color Doppler imaging in the diagnostic evaluation of patients with cervical lymphadenopathy.

Eumycetoma versus actinomycetoma: Diagnosis on cytology

Eumycetoma is a chronic cutaneous and subcutaneous infection caused by various genera of fungi producing specific colored granules known as grains. A 45-year-old farmer presented clinically with a left foot mass with multiple discharging sinuses existing for last 3 years. Clinical and radiological findings suggested a diagnosis of chronic osteomyelitis with suspicion of tuberculosis. Imprints plus fine needle aspiration cytology (FNAC) smears exhibited distinct brown-black colonies of a fungus having branching and septate hyphae embedded in matrix like material against a mixed inflammatory background. Periodic acid Schiff (PAS) stain gave positive staining and subsequent fungal culture confirmed the cytological diagnosis and aided in species identification as Madurella mycetomatis. Thus, eumycetoma can precisely be diagnosed and confidently differentiated from similar conditions such as actinomycetoma by simple and inexpensive cytological techniques such as FNAC and imprint smears, employing routine May-Grünwald-Giemsa, Papanicolaou and simple PAS stains on cytological specimen, thus leading to rapid diagnosis for institution of correct treatment.

FNA diagnosis of adrenal myelolipoma: A rare entity

Dear Dr. Bedrossian: Myelolipoma is a benign tumor consisting of mature fat interspersed with hematopoietic elements resembling bone marrow. Adrenal myelolipomas are rare benign nonfunctioning tumors that are mostly detected incidentally by imaging. These usually do not present with any symptom unless they are large enough to become clinically apparent. A 36-year-old male presented to Jaber Al-Ahmed, Armed Forces Hospital, Kuwait with an abdominal lump in the right lumbar region for the past three months. The mass was 12.5 3 6 cm in size, mobile, spherical, and firm in consistency. The patient was of average built, and his vitals and routine investigations were within normal limits. Fine-needle aspiration cytology (FNAC) under ultrasonographic guidance was done, which showed scattered cells of myeloid series along with interspersed fat cells (Fig. 1). A tentative diagnosis of adrenal myelolipoma was rendered. Right adrenalectomy was performed, and the tissue was sent for histopathological examination. On gross examination, the mass was oval in shape, yellowish brown, and measured around 12.5 cm. The cut section was bright yellow in color with foci of red–brown discoloration (Fig. 2). Microscopically, the tumor consisted mainly of mature adipose tissue with scattered islands of hematopoietic cells (Fig. 3). Thus, a diagnosis of adrenal myelolipoma was confirmed. Adrenal myelolipoma is an unusual benign lesion characterized by the presence of adult fat containing active bone marrow elements within the adrenal gland. The lesion occurs most frequently in middle life with no sex predilection. Circumscribed bone marrow like structures were first recognized by Gierke in the year 1905, but it was only in 1929 that Oberling gave the name ‘‘myelolipoma’’ for the lesion. Most of the cases are found incidentally, either at autopsy or through radiological imaging done for other reasons, primarily because these present asymptomatically. It is only when the lesion attains a large size and is predominantly fatty that it becomes clinically apparent. Myelolipoma manifests in four distinct clinicopathologic patterns: isolated adrenal myelolipoma, adrenal

Prevalence of hepatitis C virus in Aligarh: A seven year experience

Sir, Blood transfusion is life saving, but the chances of transmission of microorganisms remain a potential danger. With proper selection of donors on the basis of detailed clinical history and examination, along with the availability of a sophisticated screening procedure, the chances of transmission of diseases through transfusion have reduced considerably. However, the risk is only minimized and not ruled out. Hepatitis C virus (HCV), the main etiological agent of the clinical entity, formerly known as Non-A, Non-B Hepatitis, was discovered in 1989 by Choo et al.(1) HCV along with Hepatitis B virus (HBV) is responsible for the majority of post-transfusion hepatitis. The present study was done to determine the prevalence rate of HCV antibodies in replacement and voluntary donors attending the Blood Bank of the Jawaharlal Nehru Medical College Hospital, A.M.U., Aligarh, over a period of seven years, from January 2001 to December 2007. Out of 68173 donors, there were 44984 replacement donors and 23189 voluntary donors. No honorary or professional donor was bled. Thereafter, 5 – 10 ml of blood was withdrawn with a 10 ml syringe and subjected to anti-HCV testing, using a commercially available third generation anti-HCV ELISA kit. A majority of the donors were young males in the age group of 30 – 40 years (60%), followed by 30% donors in the age group of 21 – 30 years. HCV positive cases among the apparently healthy blood donors were assessed. In the year 2001; there was no donor who showed positivity for HCV antibody. In the year 2002, there was only one positive case per 8130 donations (0.01%). The year 2003 showed an increase in the number of positive cases for HCV, three positive cases per 9577 donations (0.03%). The year 2004 showed a further increase, with eight positive cases per 10842 donations (0.07%). The scenario in 2005 was somewhat similar to that seen in 2003, with five positive cases per 10990 donations (0.04%). There was a steep rise in 2006, with 13 positive cases per 11068 donations (0.12%). The number of positive cases continued to rise in 2007, with 18 positive cases per 11566 donations (0.15%). A majority of the positive cases belonged to the age group 21 – 30 years, 22 in total (45.83%), followed by 14 cases (29.16%) in the age group 31 – 40 years. There were seven cases (14.58%) in the second decade, while only five positive cases (10.41%) were seen in the fifth decade. The study revealed only three female positive cases out of a total of 48 positive cases (6.25%) during the entire period of study. One reason for this data could be the overall low number of female donors as compared to male donors. Transfusion-associated infections continue to be a big threat to the safety of blood supply, moreso in the developing and underdeveloped countries. Viral infections are the major cause of morbidity and mortality in blood recipients and a majority of transfusion-associated hepatitis is caused by the Hepatitis C virus. With approximately 170 million people worldwide estimated to be infected with HCV, a figure that is four times the HIV infection status, it has the potential to be the next pandemic.(2) The present study was undertaken to determine the prevalence of HCV antibodies in healthy blood donors. The presence of anti-HCV does not constitute a diagnosis of Hepatitis C, but may be indicative of recent and/or past infection by hepatitis C virus. A nonreactive test result does not exclude the possibility of exposure to HCV. Levels of anti-HCV may be undetectable in early infections due to a low titer; polymerase chain reaction (PCR) may play an important role under such circumstances. Even then, screening blood donors for anti-HCV has reduced the incidence of post-transfusion non-A and non-B hepatitis dramatically. Hepatitis C virus (HCV) is a hepatotropic virus of family Flaviviridae and genus Hepacivirus, having a single standard RNA of positive polarity as genomic material. A large number of genotypes have been identified among hepatitis C virus isolates from all over the world. Presently six main groups of sequence variants have been characterized, corresponding to types 1 – 6; each group containing a number of more closely related subtypes (a, b, c, etc.).(3) Genotype 3 is the most prevalent genotype in patients with chronic hepatitis C in North and Central India, and is associated with significant hepatic steatosis and fibrosis.(4) The safety of blood transfusion is compromised in India due to its dependence on replacement donors, endemic hepatitis in this region, high cost of screening, and a lack of funds and trained personnel. Williams et al., in 1992, conducted a study and showed a seroprevalence of 11.1% for antibodies to HCV in multiple transfused thalassemia major patients.(5) This high prevalence could have been because of improper clinical examination and screening of the donors. However, proper pre-donation screening of donors and rejecting volunteers with a past history of viral hepatitis has shown a lower prevalence of post-transfusion Hepatitis C infection (0.07%) in our study, as compared to a higher prevalence of 2.0% reported by Kothari et al.(6) Our study showed an alarming percentage of HCV positive cases in the younger generation, 36 cases (74.9%), with an upward trend of positivity, with time. Routine HCV antibody screening and proper clinical examination should be carried out in blood donors with a thrust toward youth surveillance, which will aid in delivery of safe blood.

Fine-needle aspiration diagnosis of GIST: a diagnostic dilemma.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. The authors take this opportunity to report two cases of GISTs of large bowel diagnosed on cytology and confirmed by histopathology and immunohistochemistry. Diagn. Cytopathol. 2012.

Coexistent non‐Hodgkins lymphoma and ductal carcinoma breast: Diagnosis on fine needle aspiration cytology

Synchronous occurrance of multiple neoplastic processes is not very common, and the relationship between breast cancer with lymphoproliferative diseases is unusual as well. Furthermore, breast involvement by non‐Hodgkins lymphoma is a rare event and primary breast non‐Hodgkins lymphoma is even rarer. The authors take this opportunity to report a case of primary B‐cell non‐Hodgkins lymphoma breast occurring in association with invasive ductal carcinoma in a 47‐year‐old female for its rare synchronous association. Diagn. Cytopathol. 2010.

Cutaneous metastasis in renal cell carcinoma

A case of renal cell carcinoma (RCC) occurring in a 65 year-old male presenting primarily as cutaneous metastasis to the chest, is being reported for its unusual presentation in the form of a skin nodule, even before the development of any urological presentation. RCC had metastasised to the liver as well. This case emphasises the importance of looking for a primary renal cancer in cutaneous metastasis cases as most of these patients have recurrent or multifocal metastatic disease.

Fine needle aspiration cytology diagnosis of tailgut cyst: a rare entity.

Background: Tailgut cyst is a rare tumor believed to originate from small portions of the embryonic tailgut, which normally disappear in early fetal development. It is often misdiagnosed due to the general unfamiliarity with this entity and also because of its clinical presentation similar to other more common diseases such as perianal fistulas and abscesses. Case: The authors take this opportunity to report a case of tailgut cyst in a 21-year-old Saudi female. The patient had presented with painful low back swelling, which had been gradually increasing in size. The case was diagnosed by fine needle aspiration cytology (FNAC) as tailgut cyst and later confirmed by histopathology. Conclusion: Tailgut cysts are congenital cystic hamartomatous lesions, which are rare in occurrence. They are generally benign, but malignancy has also been reported, which is even rarer in occurrence. FNAC is an effective diagnostic tool, which if applied appropriately can be used for the early detection of rarer lesions such as tailgut cyst.

The role of sediment cytology in ovarian neoplasm.

Objective: It was our aim to study the role of sediment cytology in a diagnostic evaluation of ovarian neoplasm. Methods: The present study was conducted in the Department of Pathology, Jawaharlal Nehru Medical College, AMU, Aligarh, India, over a span of 22 months. Cytological smears were prepared by centrifuging the sediment of fluid from the bottom of a container in which surgical specimens were received. Smears were fixed in 95% ethyl alcohol and then stained using hematoxylin-eosin and Papanicolaou stains. The cytological results were compared with histological diagnosis, taking the latter as gold standard. Results: Out of 54 lesions studied by sediment cytology, 22 lesions were labeled as benign, 26 lesions as malignant and 6 lesions were inconclusive. Final histological diagnoses labeled 24 lesions as benign and 30 lesions as malignant. Comparing the diagnosis of the cytology smear with the histological section, 44 out of 54 cases were concordant. A sensitivity, specificity and diagnostic accuracy of 90.3, 92.3 and 90.3% was achieved, respectively. Conclusion: Biopsy sediment cytology is a good complementary method to histopathology in the study of ovarian biopsy material. In developing countries like ours, where the facility of frozen section is not available at many centers, this simple and cheap technique can be of much help in rapid diagnosis.

FNA diagnosis of teratoma lung: A case report

A case of teratoma occurring in the lung of a 27‐year‐old female, diagnosed by fine‐needle aspiration cytology and confirmed by histopathology, is being presented here. Occurrence of teratoma at this site is a rare entity. The authors take this opportunity to report such a rare case, and as to the best of our knowledge, not many cases have been reported in literature till date. Diagn. Cytopathol. 2010;38:758–760.