Jyoti Prakash Phukan

Clinicopathological study of rhinosporidiosis with special reference to cytodiagnosis

Background: Rhinosporidiosis is a chronic infective disorder caused by Rhinosporidium seeberi. It usually presents as a soft polypoidal pedunculated or sessile mass. Nose and nasopharynx are the commonest sites, followed by conjunctiva, maxillary sinuses, penis, urethra. Aims: The aim of this study is to present the clinicopathological features of rhinosporidiosis in a large series of cases and to asses the role of cytology in diagnosis. Materials and Methods: 63 cases were included in the study group. Diagnosis of rhinosporidiosis was confirmed in all cases by histology with or without cytological evaluation. May-Grünwald-Giemsa and hematoxylin and eosin (H and E) staining was used in all cases, and special stains like periodic acid Schiff and mucicarmine were used in a few cases. Detailed clinical history of all the cases was noted. Routine hematological investigations including ABO blood grouping were done in all possible cases. Results: Evaluation of the clinical data in our series demonstrated male predominance (36 out of 63; 56%). Nose and nasopharynx were the commonest sites involved (74.6%). Routine hematology tests did not show any significant change in most of the cases. However, a significant proportion of the study population (18 out of 41; 44%) had blood group O. Cytodiagnosis attempted in 17 cases out of 63 cases achieved 100% correlation with histology. Conclusion: Morphological appearance alone in a few cases failed to give diagnosis of rhinosporidiosis. Cytology can be very helpful in diagnosis in these cases, but histology is the mainstay of diagnosis.

Lymphangioma circumscriptum of the vulva: Report of a rare case

Lymphangioma circumscriptum (LC) is a form of lymphangioma characterised by benign dilation of lymphatic channels, which affects the skin and subcutaneous tissues. The most common sites of LC are mucosa of mouth, tongue, groin, axilla, trunk and proximal region of extremities. Vulva is a rare site of LC. In this report, we are presenting a case of LC of vulva occurring in a 60-year-old female without any obvious reason. The patient presented with multiple genital wart-like papular lesions in the vulva. Biopsy of lesion reveals LC. She was treated with vulvectomy and showed no sign of recurrence till date.

Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis

Background: Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system. Aim: To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications. Study Design: Prospective non-randomized comparative study. Materials and Methods: Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using χ2 test. Results: Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8%) was involved more commonly than left eye (36.2%). Epiphora was the commonest presenting symptom (63.7%). Mean duration of surgery was much lengthier in external (mean 119.6 minutes) than endoscopic (mean 49.0 minutes) DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively (P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant (P = 0.609). Conclusion: Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.

Mullerian Adenosarcoma of Uterus with Sarcomatous Overgrowth and Heterologous Component Associated with Stromal Deposit in Omentum: A Case Report and Review of the Literature

Background. Mullerian adenosarcoma with sarcomatous overgrowth (MASO) is a very rare variant of uterine sarcomas first described by Clement et al. as early as 1974. The presence of heterologous sarcomatous components is associated with aggressive biological behavior. Case Presentation. This is a case report of a 62-year female (P2 + 0) presenting with postmenopausal vaginal bleeding. Her preoperative USG revealed subserosal fibroid with adherent omentum. She underwent abdominal hysterectomy with bilateral oophorectomy. Histopathological diagnosis of resected specimen was Mullerian adenosarcoma with sarcomatous overgrowth and presence of heterologous elements involving body of the uterus. The whole thickness of the myometrium was involved along with the presence of serosal nodules and omental deposits of sarcomatous component. Conclusion. MA is considered as a low-grade malignant tumor, but MASO is a high-grade tumor frequently associated with invasion and metastasis with poor treatment outcome. Because of its rarity, correct identification of these tumors and distinction from other uterine sarcomas are a challenging job and hence its morphological features merits attention.

Cytological grading of breast carcinoma on fine needle aspirates and its relation with histological grading

Background: Grading of breast carcinoma on fine needle aspiration cytology (FNAC) is beneficial for selecting patients for neoadjuvant chemotherapy. Aims: To grade the breast carcinoma on FNAC using Robinson grading system and to assess the concordance of cytological grading (CG) with histological grading (HG) using Elston-Ellis modification of Scarff-Bloom-Richardson grading system. Materials and Methods: The study was conducted for 1-year, comprising of 50 female patients attending outpatient departments (OPD) as well as admitted in various surgical wards of a teaching hospital, diagnosed as breast carcinoma. FNAC smears were stained with May-Grunwald-Giemsa and Papanicolaou (Pap) stains and CG was done using Robinson system on Pap stained smears. The results were compared with HG system after resection of tumors. Results: Of 50 cases, 14 (28%) cases were graded as grade I, 24 (48%) grade II, and 12 (24%) grade III by CG, whereas 9 (18%), 28 (56%) and 13 (26%) cases were graded as grade I, II and III by HG. The result showed overall 72% concordance of CG with HG, with grade II and grade III showing highest degree of concordance (83.33%), which is comparable to previous studies. Kappa measurement showed a higher degree of agreement in high-grade tumors compared with low-grade tumors (0.73 in grade III, 0.53 in grade II and 0.39 in grade I). Conclusion: Cytological grading is comparable to HG in majority of cases. Because neoadjuvant chemotherapy is becoming increasingly popular as primary treatment modality of breast cancer, CG could be a useful parameter in selecting the mode of therapy and predicting tumor behavior.

Evaluation of Ultrasound-Guided Fine-Needle Aspiration Cytology of Ovarian Masses with Histopathological Correlation.

Background: Preoperative cytodiagnosis of ovarian masses is a difficult process, and sampling of pelvic masses is quite easier after the improvement of imaging techniques. Though histopathology is the gold standard, fine-needle aspiration cytology (FNAC) under ultrasound (US) guidance can be a valuable tool for pre-operative diagnosis of ovarian lesions, especially in the hands of an experienced pathologist. Objective: The present study was performed to evaluate the role of US-guided FNAC in pre-operative cytological diagnosis of ovarian masses in comparison with histopathology, and to assess the pitfalls and limitations of cytological interpretation. Materials and Methods: This study was conducted over a 2-year period on 70 cases of ovarian masses, which were evaluated by US-guided FNAC. Sensitivity, specificity and diagnostic efficacy were calculated using histopathology as gold standard. Results: On cytological evaluation, non-neoplastic cysts, and benign and malignant ovarian tumours were diagnosed in 8, 18 and 40 cases, respectively. On histopathology, 62 cases were concordant with cytology. Sensitivity and specificity were 95.23 and 95.83%, respectively, in the present study. Diagnostic accuracy was 93.94% in respect to the correct diagnosis. Cytohistological discrepancies and limitations of the study are discussed. Conclusion: US-guided FNAC has proved as a quick, economic and safe procedure in diagnosing ovarian masses with brilliant accuracy.

Preoperative Diagnosis of Tubular Adenoma of Breast - 10 years of experience.

Background: Tubular adenomas are rare benign neoplasms of female breast affecting women, predominantly of child-bearing age group. Definitive diagnosis of this tumor is usually achieved after histopathological study. Clinical, radiological, and even cytological features are often insufficient for accurate diagnosis. Aim: The aim of the present study was planned to analyze clinical and radiological features of histologically confirmed cases of tubular adenoma of breast to find out a clue for accurate preoperative cytological diagnosis. Materials and Methods: In our 10-year research program, all histologically confirmed tubular adenoma cases of breast were studied. Clinico-radio-cytological features, if available, were analyzed and tabulated. Results: Thirty-three cases of tubular adenoma of breast were studied. Radiological and cytological assessments are available for 12 and 26 cases, respectively. Tubular adenoma could be diagnosed in only two cases (7.7%) by cytological assessment, but in none by radiological assessment. Conclusions: Clinico-cyto-radiological assessment could identify the benign nature of the tumors in most cases, but final confirmation was possible only after histopathological study.

Fine needle aspiration cytology of eccrine spiradenoma of back: Report of a rare case

Eccrine spiradenoma is an uncommon benign adnexal tumor. Cytological features of eccrine spiradenoma have been described very rarely in English literature. In the present case, we are describing a case of eccrine spiradenoma of back, which was diagnosed by fine-needle aspiration cytology and subsequently confirmed by histopathology. Its cytology revealed tight multilayered clusters of uniform benign cuboidal epithelial cells along with spindle-shaped myoepithelial cells and occasional lymphocytes.

Serum lipid profile in alcoholic cirrhosis: A study in a teaching hospital of north‑eastern India

Background: Alcoholic cirrhosis is often associated with impaired lipid metabolism. However, there are only a few studies regarding lipid profile in alcoholic cirrhosis that have been undertaken in India. The aim of the study is to assess the degree of alteration of serum lipid profile in alcoholic cirrhotic patients and also to detect its relationship with the age of the patients and the alcohol consumption pattern. Patients and Methods: This cross-sectional study was conducted in a teaching hospital of north-eastern India for 1 year with 100 patients with alcoholic cirrhosis (cases) and 50 healthy individuals (controls) without history of alcohol consumption. A questionnaire of personal characteristics including history of alcoholism was completed for each patient. Serum lipid profile (total, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol and triglyceride) was recorded for each case and control. t test of significance was applied for statistical analysis. Results: Majority of the cases were in the 41-50 years age group. There was no relationship of cirrhosis with the type of alcoholic beverage, but a definite relationship was observed with the quantity and the duration of alcohol consumption. In patients with cirrhosis, the total serum cholesterol level was decreased. There was a significant decrease in serum HDL and LDL cholesterol compared with the control group ( P < 0.001). However, the serum triglyceride levels were significantly increased in alcoholic cirrhotic patients compared with the control group ( P < 0.001). Conclusion: In this study, we found that there was marked alteration of serum lipid profile values in patients with alcoholic cirrhosis compared with normal, non-cirrhotic individuals. Therefore, a search for lipid profile abnormality should be performed in every cirrhotic patient.

Cytodiagnosis of Pilomatrixoma from an Uncommon Site with Unusual Presentation

Pilomatrixoma or pilomatricoma is an uncommon benign tumor of hair matrix origin, which most commonly occurs in the head and neck region and upper extremities. In this study, we report a case of pilomatrixoma of a 35-year-old female presenting with left-leg swelling with surface ulceration, clinically thought to be malignant. Fine-needle aspiration cytology (FNAC) of the lesion showed clusters of basaloid cells with round to ovoid nuclei, nucleated squamous cells, and anucleated squames and clusters of shadow cells. Acytological diagnosis of pilomatrixoma was made. Subsequent surgical excision and histopathological examination confirmed the diagnosis. This case highlights a rare site of presentation and the role of FNAC in preoperative diagnosis of this benign tumor for proper management.