Kanchan Kothari

Utility of the Paris System in Reporting Urine Cytology

Objective: To find out the utility of The Paris System (TPS) in reporting urine cytology and to compare it with the reporting system currently used in our laboratory. Study Design: This retrospective study was undertaken over a period of 1 year during which slides of all the urine specimens sent for cytological examination were retrieved from our laboratory filling system. They were blindly reviewed and reclassified according to TPS. Surgical follow-up was obtained from the uropathology services of our department. Results: A total of 176 cases were meticulously reviewed. The mean age of the patients was 52 years, and 71% of cases presented with hematuria. Histopathological follow-up was available in 34 cases. Reporting by TPS detected 13.0% high-grade urothelial carcinoma (HGUC) and 5.1% atypical urothelial cells versus 7.3 and 11.9% by the current reporting system, respectively. The sensitivity and diagnostic accuracy for detecting HGUC of TPS were higher than those of our reporting system. Conclusion: TPS has increased the rate of detection of HGUC and reduced the rate of reporting “atypical” urothelial cells. TPS has also standardized the diagnostic criteria, thereby bringing uniformity and reproducibility into the system of reporting for urine cytology.

Dysplastic Megakaryocytes and Eosinophilic Precursors in the Diagnosis of Myeloid Sarcoma on Lymph Node Fine-Needle Aspiration Cytology: A Case Series

Objective: To analyze the cases diagnosed as myeloid sarcoma on fine-needle aspiration cytology (FNAC) of lymph nodes. Study Design: Ten cases of lymph node aspirate diagnosed as myeloid sarcoma were analyzed. FNAC was performed as a routine outpatient procedure in all cases. Correlation with peripheral smear, bone marrow examination, flow cytometry and cytogenetics was done wherever possible. Results: Diagnosis of a hematologic malignancy, before fine-needle aspiration, was available in only 2 cases. All 10 cases showed eosinophilic precursors while five aspirates showed megakaryocytes with dysplastic forms. Of the 10 cases, 3 were diagnosed as acute myeloid leukemia, 3 as chronic myeloid leukemia, 1 case as juvenile myelomonocytic leukemia, 1 case proved to be precursor T acute lymphoblastic leukemia/lymphoma and 2 patients did not show blasts on peripheral blood smear but showed blasts, dysplastic megakaryocytes and eosinophilic precursors in the aspirate. Conclusion: Thorough workup to search for an underlying hematological malignancy should be done whenever dysplastic megakaryocytes and/or eosinophilic precursors are seen in lymph node aspirate.

Duodenal biopsy in malabsorption-A clinicopathological study

Aims: To study the morphologic spectrum of duodenal biopsy specimens in malabsorption, to correlate the histology with clinical, endoscopic and serological investigations and to assess various aetiologies of malabsorption. Material and Methods: Duodenal biopsies of 50 patients presenting with symptoms of malabsorption were analysed over a period of one year. The clinical details of patients, including their routine blood investigations, serology for Serum tissue transglutaminase (IgA t TG) and Upper gastrointestinal (UGI) endoscopic findings were noted. The villous architecture, villous to crypt ratio (V: C ratio), crypt examination and Intraepithelial lymphocytes were counted. Other findings like presence of parasites, dilated lymphatics, granulomas were also noted down. Results and conclusions: The mean age of presentation was 32.5 years, with a mild female preponderance. Endoscopic mucosal abnormalities were found in 42% of cases and microscopic villous atrophy in 46% of cases. Increase in IELs was found in 48% of cases. Celiac disease was the leading cause (28%) of malabsorption whereas Tropical sprue accounted for only 4% of cases. Not a single case of tuberculosis was encountered. Keyword: Duodenal biopsu, Malabsorption, Celiac diseases, Intraepithelial lymphocytes, Rillous architecture Access this article online Quick Response Code: Website: www.innovativepublication.com

Fine-Needle Aspiration Cytology of Breast Lesions with Spontaneous Infarction: A Five-Year Study

Objective: To put forth the cytological features and diagnostic pitfalls of spontaneously infarcted breast lesions on fine-needle aspiration cytology (FNAC). Study Design: We present 19 cases of spontaneously infarcted breast lesions encountered on FNAC over a 5-year period. Histological follow-up was correlated wherever available. Results: The majority of cases were seen in the second decade of life. The smears in all 19 cases were cellular. The cytomorphologic findings were scattered dyscohesive cells (n = 16), ghost cells (n = 11) and necrosis (n = 10). The dyscohesive cells were small and had a normal nuclear cytoplasmic ratio with pyknotic nuclei. The presence of viable epithelial cells or stromal fragments helped in the diagnosis of the primary breast lesion and was seen in all 19 cases. Cytology diagnoses were infarcted fibroadenoma (n = 11), infarcted breast lesion (n = 3), Phyllodes tumor (n = 2), papillary lesion (n = 2) and infarcted benign breast lesion (n = 1). Histopathology was available in 13 cases, 12 were concordant and 1 was inadequate for primary diagnosis. Conclusion: An infarcted breast lesion poses diagnostic difficulties on cytology. It needs to be differentiated from inflammatory lesions and malignancy. A cytopathologist should be aware of the entity and recognize its cytomorphologic features.

Disseminated histoplasmosis in an immunocompetent patient - utility of skin scrape cytology in diagnosis: a case report

BackgroundHistoplasma capsulatum is a dimorphic fungus predominately found in soils enriched with bird and bat excreta. Although several cases of histoplasmosis have been reported in India, diagnosis using cytology has been done in very few cases.Case presentationWe report here a case of disseminated histoplasmosis in a 46-year-old Indian man.ConclusionSkin scrape cytology is a simple, safe, and rapid technique to establish the initial diagnosis, thus promoting early treatment and favorable outcome, in cutaneous fungal infections.

Cytologic diagnosis of unusual, large multiple cutaneous myxomas in a case of Carney complex

Cutaneous myxomas are rare benign neoplasms which are frequently associated with Carney complex (CNC). Although more than 500 cases of CNC are reported, there is no literature on cytologic diagnosis of Cutaneous myxomas. An 18-year-old male, with no significant family history, presented with multiple cutaneous swellings, largest measuring 15 cm on the right cheek. He also had spotty skin pigmentations, raised adrenocorticotropic hormone levels and recurrent cardiac myxomas. Fine-needle aspiration cytology from the right cheek and suprapubic swellings revealed paucicellular smears with abundant myxoid material in the background, admixed with fragments of spindle and stellate cells with bland nuclear morphology, and vascular proliferation in few fragments. There was no mitosis, necrosis, or any epithelial element. Hence, diagnosis of cutaneous myxomas in CNC was made which was confirmed on histopathology. This is the first report of cytologic diagnosis of multiple cutaneous myxomas in CNC and the largest cutaneous myxoma reported in literature.

Eccrine Spiradenoma of the Vulva

A 23-year-old woman presented with a gradually increasing swelling on the left labia majora since 2 years. The lesion measured approximately 1.5 9 1 cm and was soft, well circumscribed and slightly painful and tender. Clinical impression was lipoma and was excised. Histopathologic examination showed well-demarcated multiple basophilic tumour nodules, comprising of lobules of round–oval cells arranged in acinar, trabecular and diffuse pattern. The stroma surrounding these lobules was hyalinised. Two types of distinctive cells were observed: the periphery showed small, dark, basaloid cells, with hyperchromatic nuclei, while cells with large nucleus and pale cytoplasm were located in the centre and towards the lumen (Fig. 1a, b). Mild to moderate lymphocytic infiltrate and many blood vessels were also observed. The histomorphology was characteristics of an eccrine spiradenoma. The vulvar region contains dense apocrine glands, anogenital mammary-like glands, eccrine glands and folliculosebaceous units [1]. Benign and malignant lesions derived from these adnexal structures are found in the vulva but are rare [1]. Baker et al. [1] in his retrospective study of 32 years identified 189 vulvar adnexal lesions. Most of these lesions were benign (70%), with hidradenoma papilliferum being the most common, followed by syringoma and various types of cysts [1]. Other lesions included were rare cases of tubular adenoma, poroma, spiradenoma, hidradenoma, cylindroma, sebaceoma and trichoepithelioma [1]. He identified only two cases of spiradenoma, but details were not documented. Eccrine spiradenoma (ES) is an uncommon benign adnexal neoplasm originating from the eccrine glands and has characteristic clinical and histomorphological features [2]. It usually occurs in the 2nd–4th decade of life as a painful solitary well-circumscribed dermal nodule with pink or blue hue [2]. Rarely, it may present as multiple lesions in a linear zosteriform pattern [2]. The lesion is one of the classically painful cutaneous lesions, others being angiolipoma, endometrioma, dermatofibroma, neuroma, neurilemmoma, glomus and leiomyoma [3]. The common sites for ES are head and neck, upper trunk or extremities [4]. There are sporadic case reports of unusual sites which includes breast, ear, nail fold and face [4]. Vulva is a very rare site and not reported. Histologically, ES is a well-circumscribed dermal tumour showing multiple basophilic nodules surrounded by hyalinised stroma, resembling lymph node when observed under a low power microscope. The pathognomonic features are the presence of two-cell populations: a central cluster of pale large cells surrounded by small, dark, basaloid cells, with hyperchromatic nuclei [2]. In certain cases, lymphocyte infiltrate and significant vascular proliferation can be observed. Dermal cylindroma is a close differential diagnosis of ES, but its commonest site of occurrence is scalp and displays ‘‘jigsaw puzzle’’ pattern of tumour cells with prominent hyaline matrix on histology [2]. Other differentials include trichoepithelioma and glomus tumour. ES can be syndromic (Brooke–Spiegler syndrome) and also has a potential for malignant transformation. Malignant spiradenoma generally arise in a long-standing benign ES [5]. Thus, early and correct diagnosis is critical. Occurrence at rare sites can cause diagnostic difficulties, but knowledge of characteristic morphology will navigate towards the right diagnosis. & Mona Agnihotri mona.agnihotri2@gmail.com

Endoscopic ultrasound guided brush/fine-needle aspiration cytology: A 15-month study

Endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) has become increasingly popular for the diagnosis and staging of gastrointestinal diseases and peri‐gastrointestinal lesions. The application of FNA/Brush has dramatically expanded the clinical utility of EUS.

Gastrointestinal Stromal Tumor: A CytologistâÂÂs Perspective

Introduction: Gastro-intestinal stromal tumors are mesenchymal tumors they have a unique immunophenotype, expressing c-KIT (CD117), DOG-1 and CD34 in most cases. Most commonly occurring in small intestine and stomach. Case report: We report a case of EUS guided FNA from gastric mass in a 60 year old patient. Cytology showed cellular smears with palisade of tumor cells and blunt end spindle cells. Discussion: GIST is very difficult to differentiate from other benign tumors i.e. leiomyoma and schwannoma. EUS guided FNA can be a very useful tool in approaching deep seated intra-abdominal lesion with ease. It also helps in diagnosis and treatment of the disease in a better way.

Anaplastic large cell lymphoma: A great mimic on cytology

Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma, accounting for <5% of non-Hodgkins lymphoma. Cutaneous involvement can be primary or secondary arising in systemic ALCL. The diagnostic feature in both is the presence of pleomorphic, CD30 positive hallmark cells. We present a case of ALCL in a 19-year-old male presenting as an ulcerated scalp swelling. Clinical impression was actinomycosis or scrofuloderma. Cytology smears showed large dispersed pleomorphic cells with hyperlobated nuclei and multinucleated giant cells. The differentials considered were ALCL, rhabdomyosarcoma, and poorly differentiated carcinoma. Immunocytochemistry (ICC) showed positivity for leukocyte common antigen (LCA) and CD30 while negativity for desmin, favoring ALCL. Computed tomography (CT) showed a lytic paravertebral lesion. Subsequently, both paraspinal and scalp lesions were biopsied and immunochemistry confirmed the diagnosis of ALCL. Thus, cutaneous involvement in ALCL can resemble inflammatory and other neoplastic lesions clinically and cytologically. Hence, a high index of suspicion and ICC can aid in the correct diagnosis on fine needle aspiration cytology (FNAC).