Jyoti R. Kini

Apocrine (cutaneous) sweat gland carcinoma of axilla with signet ring cells: A diagnostic dilemma on fine-needle aspiration cytology

Carcinoma arising in the apocrine sweat glands is rare and there are few reports describing the cytological features of this neoplasm. We describe the cytological features of a histologically confirmed apocrine carcinoma occurring in a 55‐year‐old man who presented with an ulcerated mass in the right axilla. Fine‐needle aspiration cytology revealed features of a signet ring adenocarcinoma. The significance of this infrequently encountered neoplasm lies in its potential for diagnostic confusion with more common lesions containing signet ring cells. In an axillary mass lesion, cytological features along with clinical correlation are essential to distinguish primary apocrine carcinoma from mammary neoplasms with signet ring cells and other metastatic adenocarcinomas. Diagn. Cytopathol. 2008;36:739–741.

Study of the reproducibility of the 2004 World Health Organization classification of urothelial neoplasms.

The aim of the study was to evaluate urinary bladder biopsies showing papillary urothelial neoplastic lesions based on the 2004 WHO/ISUP classification of Urothelial Neoplasms of the Urinary Bladder, to assess the reproducibility of the bladder carcinoma grade. Fifty consecutive transurethral tumor resection biopsies were evaluated by four pathologists independently. The final diagnoses of each pathologist were subjected to statistical analysis to assess the degree of interobserver variability and reproducibility of this classification. Significant interobserver variation was found in the reporting of urothelial neoplasms. In 22 instances there was difference in opinion between PUNLMP and low-grade carcinoma, and in 59 instances between low and high grade carcinoma. The 4 observers never unanimously agreed on the diagnosis of PUNLMP.

Lipofibromatous Hamartoma of the Median Nerve in Association with or without Macrodactyly

Lipofibromatous hamartoma is a rare tumour-like condition involving the peripheral nerves, particularly the median nerve. It commonly affects the volar aspect of the hands, wrists and forearms of young adults. Most patients present either early with macrodactyly or later with a forearm mass lesion or symptoms consistent with compressive neuropathy of the involved nerve. The clinical and histomorphological findings of five patients with lipofibromatous hamartoma of the median nerve are analysed. The presentation, pathological features and differential diagnosis of neural lipofibromas are discussed along with a brief review of the literature. Of the five cases of lipofibromatous hamartoma, all were seen to involve the median nerve, occurring in four women and one man. Three of these cases had associated macrodactyly which was congenital in two and was seen from childhood in one. Microscopic examination showed fibrofatty tissue surrounding and infiltrating along the epineurium and perineurium. The nerve bundles were splayed apart by the infiltrating adipose tissue. Neural fibrolipomatous hamartoma is a benign condition. Most respond to conservative management with surgical exploration, biopsy and carpal tunnel release to decompress the nerve. Correct diagnosis of this uncommon lesion is important as surgical excision of the lesion may lead to loss of neurological function.

Adrenal gland cyst: A diagnostic conundrum: Report of a case with review of literature

Cystic lesions of the adrenal gland are uncommon and mostly asymptomatic. They demonstrate a spectrum of histological changes and may vary from pseudocysts to malignant cystic neoplasms. Adrenal pseudocysts are rare cystic lesions surrounded by a layer of fibrous tissue that lack a recognizable lining layer. They are most often discovered incidentally during radiological studies or at autopsy. The radiographic appearance of adrenal pseudocysts though characteristic, can be difficult to distinguish an adrenal pseudocyst from an adrenal neoplasm with prominent cystic change, presenting as diagnostic conundrums. Extensive sampling of resected tissues is important to rule out malignancy in patients, with cystic adrenal lesions. Herein, we present a 47- year-old male with a non functional and asymptomatic left adrenal pseudocyst. The literature is reviewed and the different diagnostic and management options are discussed.

Value of bone marrow examination in Hodgkin lymphoma: Report of three cases with review of literature

Bone marrow involvement by Hodgkin lymphoma is rare with an average incidence of 10%. However, the incidence of bone marrow involvement has been shown to be less than 1% in patients with clinical stage IA or IIA disease. The involvement of the marrow in a patient with Hodgkin lymphoma represents stage IV disease. We report our experience wherein three cases of marrow involvement were picked up on bone marrow aspirates/ -imprints and confirmed on trephine biopsy. In this paper we wish to highlight the significance of bone marrow examination in the initial diagnosis and staging of even clinically early stage Hodgkin lymphoma. Staging investigations performed at the time of diagnosis for patients with Hodgkin lymphoma are vital for determining the appropriate treatment and prognosis.

Disseminated histoplasmosis with conjunctival involvement in an immunocompromised patient.

We report a case of disseminated histoplasmosis in a 37-year-old male acquired immunodeficiency syndrome patient from south India. The patient presented with high-grade fever, cough, conjunctival nodule and papulonodular hyperpigmented skin lesions. Histology of skin lesions and conjunctival nodule showed numerous intracellular Periodic Acid Schiff-positive rounded yeast cells within macrophages. Bone marrow aspirate confirmed disseminated histoplasmosis. The patient showed dramatic response after starting treatment with Amphotercin B.

Imprint cytology of pancreatoblastoma: A case report and review of the literature

Pancreatoblastoma is a rare tumor with ∼60 cases described in the English literature and only five case reports illustrating the cytologic findings, four by fine‐needle aspiration cytology and one by imprint cytology. We herein report the sixth case diagnosed by imprint cytology. Both the cytologic and histopathologic literatures are reviewed, and the pathologic variations observed in our case are also documented. Diagn. Cytopathol. 2009.

A study about color normalization methods for histopathology images

Histopathology images are used for the diagnosis of the cancerous disease by the examination of tissue with the help of Whole Slide Imaging (WSI) scanner. A decision support system works well by the analysis of the histopathology images but a lot of problems arise in its decision. Color variation in the histopathology images is occurring due to use of the different scanner, use of various equipments, different stain coloring and reactivity from a different manufacturer. In this paper, detailed study and performance evaluation of color normalization methods on histopathology image datasets are presented. Color normalization of the source image by transferring the mean color of the target image in the source image and also to separate stain present in the source image. Stain separation and color normalization of the histopathology images can be helped for both pathology and computerized decision support system. Quality performances of different color normalization methods are evaluated and compared in terms of quaternion structure similarity index matrix (QSSIM), structure similarity index matrix (SSIM) and Pearson correlation coefficient (PCC) on various histopathology image datasets. Our experimental analysis suggests that structure-preserving color normalization (SPCN) provides better qualitatively and qualitatively results in comparison to the all the presented methods for breast and colorectal cancer histopathology image datasets.

Evaluation of p53 protein expression in Barrett esophagus

Background: Loss of heterozygosity of p53 along with aneuploidy is deemed to be the early molecular steps in Barrett metaplasia-dysplasia-adenocarcinoma sequence. Objective biomarkers need to be used along with microscopy for risk stratification to predict the progression of Barrett esophagus (BE) to carcinoma. Aim: This study aims to study p53 protein expression in dysplasia and correlate the same with morphology in BE. Materials and Methods: A time-bound study was conducted from January 2011 to June 2015. All esophageal biopsies showing histological evidence of columnar epithelium with the presence of goblet cells were included. The cases which showed dysplasia were graded on hematoxylin and eosin stain. Evaluation of p53 immunohistochemistry staining was done on all the cases of BE. Dysplasia was correlated with the expression of p53 using Chi-square value (χ2) and Fischers exact test wherever appropriate. P < 0.05 was considered to be statistically significant. Results: Of 829 esophageal biopsies received, 119 were endoscopically suspected to be BE, of which 85 cases were confirmed on microscopy. In our study, there were 75 cases negative for dysplasia (88.2%), 8 with low-grade dysplasia (LGD) (9.4%), and two with high-grade dysplasia (HGD) (2.4%). Three cases of BE had associated adenocarcinoma. Immunostaining with p53 done on all the 85 cases showed positive staining in all cases with LGD, one with HGD and two with adenocarcinoma. In the present study, immunostaining with p53 showed 90% sensitivity, 89.3% specificity, positive predictive value of 52.9%, and negative predictive value of 98.5%. Conclusion: The technical simplicity, easy availability, and comparatively lower cost enhance the role of p53 as a biomarker in risk stratification for patients with BE.

The Role of Crush Cytology in the Diagnosis of Large-Intestine Lesions with Correlation on Histopathology

Objective: To study the efficacy of colonoscopic crush cytology as a convenient and near-accurate method to evaluate colonic neoplasms. Study Design: Retrospective and cross-sectional. The original cytologic diagnoses were correlated with a histology report on 100 cases sent to the cytology laboratory over 2 years. Results: Of the 100 cases, 25 were nonmalignant. Of the 75 malignant lesions, 72 could be identified as positive for malignancy on cytology. The false-positives consisted of 6 adenomas and 1 case of ulcerative colitis. Thus, sensitivity and specificity of cytology are 96 and 63.2%, respectively. Of the 6 adenomas diagnosed as malignant, 4 showed high-grade dysplasia, and the other 2 showed superficial ulceration with low-grade dysplasia on histopathology. The ulcerative colitis case showed widespread ulcers and regenerative/reparative features on biopsy. The 3 adenocarcinomas diagnosed s benign on cytology showed an occasional malignant cell with thickened nuclear borders and prominent central nucleoli. Conclusions: With careful attention to the cytomorphology, coupled with good clinical and endoscopic correlation, crush cytology of the large intestine is a reliable diagnostic tool. It categorizes lesions as malignant and benign with a high sensitivity, positive predictive value, and negative predictive value. Adenomas and reparative/regenerative changes seen in inflammatory bowel disease are major pitfalls in the cytology diagnosis of malignancy that may be averted by informing the endoscopic findings and clinical history. Cytology diagnosis saves time and gives proper feedback to the gastroenterologist.