Monisha Choudhury

ORIGINAL RESEARCH—ENDOCRINOLOGY: A Comparative Study of the Effects of Local Estrogen With or Without Local Testosterone on Vulvovaginal and Sexual Dysfunction in Postmenopausal Women

INTRODUCTION A significant number of postmenopausal women suffer from distressing problems because of urogenital atrophy secondary to the decline in circulating estrogen levels. Treatment with topical hormones may provide relief in such women when used judiciously. AIM To study the effects of local estrogen with or without local testosterone on urogenital and sexual health in postmenopausal women. METHODS Seventy-five postmenopausal women symptomatic for urogenital atrophy and sexual dysfunction were randomly divided into two study groups and one control group. The women in study group 1 received local estrogen cream; study group 2 received local estrogen and testosterone cream; the control group received nonhormonal lubricant KY gel for 12 weeks. The urogenital and sexuality score, along with the vaginal health index and the vaginal maturation index (VMI), was calculated at the beginning of therapy and 12 weeks later. MAIN OUTCOME MEASURES Changes in the urogenital and sexuality score along with vaginal health index and VMI. RESULTS After 12 weeks of therapy, there was a significant improvement in all the four study parameters, which correlated well with the improvement in symptoms of urogenital atrophy and sexual dysfunction in both the study groups as compared with the control group. Improvement in sexuality score was greatest with combined estrogen-androgen therapy. There were no adverse effects and the therapies were well accepted without any compliance issue. CONCLUSION Local estrogen either alone or with androgen is highly effective in relieving symptoms of urogenital atrophy and in improving sexual function in symptomatic postmenopausal women.

Localized Tenosynovial Giant Cell Tumor of Tendon Sheath

BACKGROUND Localized tenosynovial giant cell tumor of tendon sheath (TGCT-L) is a benign, slowly growing lesion with a peak incidence in the third to fifth decade of life. It is thought to arise from the synovium of tendon sheaths, frequently affecting interphalangeal joints of the hands, feet, ankles and knees. Although the histopathologic appearances are well established, only a few reports describe the cytomorphology of this lesion. CASE A 37-year-old female presented with a slowly growing, nontender mass located near the left ankle joint. The cytologic features of localized tenosynovial giant cell tumor of tendon sheath (TGCT-L) include abundant mononuclear histiocytic cells occurring singly and in three-dimensional tissue fragments, hemosiderin within histiocytes and a few multinucleated giant cells. Subsequently, the histopathologic examination of the surgical specimen was proven to be TGCT-L. CONCLUSION Fine needle aspiration cytology can be used as a diagnostic tool for early and accurate detection of TGCT-L since the cytologic features combined with clinical details are sufficiently distinctive.

Evaluation of Sentinel Node Biopsy in Locally Advanced Breast Cancer Patients Who Become Clinically Node-Negative after Neoadjuvant Chemotherapy: A Preliminary Study

Introduction. Controversy continues over the appropriate timing of sentinel lymph node (SLN) biopsy in locally advanced breast cancer (LABC) patients receiving neoadjuvant chemotherapy. We evaluated the feasibility and accuracy of SLN biopsy in LABC patients with cytology-proven axillary nodal metastasis who become clinically node-negative after neoadjuvant chemotherapy. Materials. 30 consecutive patients with LABC, who had become clinically node-negative after 3 cycles of neoadjuvant chemotherapy, were included in the study. They were then subjected to SLN biopsy, axillary lymph node dissection, and breast surgery. Results. Sentinel nodes were successfully identified in 26 of the 30 patients, resulting in an identification rate of 86.67%, sensitivity of 83.33%, false negative rate of 20%, negative predictive value of 72.73%, and an overall accuracy of 88.46%. No complications were observed as a result of dye injection. Conclusions. SLN biopsy is feasible and safe in LABC patients with cytology-positive nodes who become clinically node-negative after neoadjuvant chemotherapy. Our accuracy rate, identification rate, and false negative rate are comparable to those in node-negative LABC patients. SLN biopsy as a therapeutic option in LABC after neoadjuvant chemotherapy is a promising option which should be further investigated.

Primary diagnosis of ameloblastoma by fine‐needle aspiration: A report of two cases

Ameloblastoma is the most common epithelial odontogenic tumor, comprising 1% of tumors and cysts arising in the jaws. We describe two cases of ameloblastoma of the jaw diagnosed by fine‐needle aspiration cytology. The patients presented with swelling in the parotid region. Cytological examination of the particulate and sticky bloodstained fluid obtained on aspiration showed tightly packed groups of basaloid cells arranged in nests with rounded edges. Palisading epithelial cells and squamous cells with spherical keratinized bodies were the distinctive cytological features. Histologic examination confirmed the presence of ameloblastoma. Diagn. Cytopathol. 2000;23:414–416.

Diagnostic utility of ki67 and p53 immunostaining on solitary thyroid nodule - A cytohistological and radionuclide scintigraphic study

BACKGROUND For management of thyroid nodules, distinction between benign and malignant tumors is essential. Present study was undertaken to differentiate between benign and malignant lesions by using Ki-67 and p53 immunostaining and radionuclide perfusion scan. MATERIALS AND METHODS Study comprised of 25 prospective and 25 retrospective cases of solitary thyroid nodules. Fine needle aspiration was done on 25 prospective cases, which was correlated with histopathological diagnosis in 24 surgically excised cases. Immunostaining for p53 and Ki-67 was put on histopathological sections of 25 retrospective and 24 prospective cases. Radionuclide perfusion scan was performed and vascularity patterns were compared with their pathological nature to differentiate between benign and malignant nodule. RESULTS Cytohistological correlation was present in 80% of cases. On immunostaining, significant difference in mean value of Ki67 positivity was found between benign and malignant nodules (P < 0.05). On p53 immunostaining significant difference was observed in counts of benign and malignant lesions (P = 0.037). On radionuclide perfusion scan mean of difference between maximum and minimum perfusion activity between benign and malignant nodules was found to be statistically significant (P = 0.04), however there was no correlation between perfusion patterns and antigenic characteristics. CONCLUSIONS P53 and Ki-67 immunostaining along with radionuclide perfusion scan appears to be useful tools to differentiate between benign and malignant lesions in solitary thyroid nodule; however, more studies are needed to confirm this observation.

Efficacy of bronchial brush cytology and bronchial washings in diagnosis of non neoplastic and neoplastic bronchopulmonary lesions.

OBJECTIVE The present study is based on the cytologic evaluation of bronchial brushings for the diagnosis of non neoplastic and neoplastic bronchopulmonary lesions and relation of the cytologic findings with clinical diagnosis and histopathologic examination wherever possible. MATERIAL AND METHOD 35 symptomatic patients were selected on whom bronchoscopy was done. Bronchial brushing was performed using straight brushes and bronchial washing specimens were collected after brushing samples. Smears were stained by Pap, H&E, and Giemsa in all the cases while PAS and Ziehl Neelsen stainings were done in selected cases. Endobronchial biopsy was performed using a flexible long biopsy forceps. RESULTS The age of the patients varied from 18 to 88 years, and the male:female ratio was 3.3:1. Carcinoma was diagnosed in 21 (60%) out of total 35 cases on bronchial biopsy and the remaining 14 cases (40%) showed inflammatory, tuberculous or no significant pathology. Bronchial washing showed 10 true positive, 10 true negative, 4 false positive and 11 false negative cases whereas bronchial brushing showed 17 true positive, 12 true negative, 2 false positive and 4 false negative cases as confirmed on biopsy. Bronchial brushing showed good sensitivity (80.9%) and specificity (85.7%) compared to bronchial washing which had sensitivity of 47.6% and specificity of 71.4%. CONCLUSION These findings attempted to confirm the concept that pulmonary cytology has improved to the point that its sensitivity is high enough to justify its use as a definitive diagnostic tool in those cases in which tissue diagnosis is not possible.

Idiopathic eosinophilic cholecystitis with cholelithiasis: a report of two cases.

Abstract Eosinophilic cholecystitis is a rare entity diagnosed on the basis of classical presentation of cholecystitis with presence of more than 90% eosinophilic infiltration within the gall bladder. The etiology of eosinophilic cholecystitis still remains obscure. However it is frequently associated with other more severe diseases like hypereosinophilic syndrome, eosinophilic-myalgia syndrome, parasitic infestations, few herbal medicines and certain drugs. We report two cases who presented with gall stone disease, which on histopathological evaluation was diagnosed as eosinophilic cholecystitis. Retrospective analysis of their case histories and investigation did not reveal any known etiology. These cases are being reported because of their rarity and to highlight the importance of complete workup to rule out other associated disorders that may be a manifestation of a more severe disease. ÖZ Eozinofilik kolesistit, safra kesesinde klasik kolesistit tablosu yanı sıra, %90’nın üzerinde eozinofilik lökosit infiltrasyonu ile tanı konan nadir bir antitedir. Eozinofilik kolesistitin etiyolojisi hala açık değildir. Bununla birlikte hipereozinofilik sendrom, eozinofili-miyalji sendromu, parazitik enfestasyonlar, bitkisel tıp veya diğer bazı ilaçların kullanımı gibi daha ciddi hastalıklarla da sıklıkla ilişkilidir. Safra kesesi taşı ile gelen ve histopatolojik inceleme ile eozinofilik kolesistit tanısı verilen iki olgu sunulmaktadır. Olguların özgeçmişlerinin retrospektif incelemesi ve klinik araştırmalar özel bir etiyoloji ortaya koymamıştır. Olgular, hastalığın nadir görülen bir antite olması ve ilişkili olabileceği daha ciddi hastalıkların dışlanabilmesi sürecindeki çalışmanın önemini ortaya koymak amacıyla sunulmuştur.

A case of leiomyosarcoma of kidney clinically and radiologically misdiagnosed as renal cell carcinoma.

Our patient was initially diagnosed to have liver abscesses. Although amoebic liver abscess is the predominant cause of liver abscess in India, hepatocellular carcinoma with necrosis and metastatic colonic cancer with central necrosis need consideration in the differential diagnosis. Only one case of PHL mimicking liver abscess[3] has been reported earlier. Lymphomas may cause portal venous obstruction either by direct infiltration, extrinsic compression at the porta by lymph nodes, tumor thrombus of the portal vein or by a hypercoagulable state. Direct portal infiltration was probably the cause in the present case. PHL causing portal venous obstruction has not been reported, although tumor thrombus in the portal vein has been described in patients with secondary lymphoma.[4]

Malakoplakia of bone: a case report

BACKGROUND Malakoplakia is an uncommon but distinctive granulomatous disease, characterized by an accumulation of histiocytes or Von Hansemann cells containing intracytoplasmic, laminated Michaelis-Gutmann bodies. CASE A 3-year-old male presented with a tender swelling in the left gluteal region that had been present for one month. Smears made from a fine needle aspirate showed large histiocytic cells containing intracytoplasmic, basophilic, laminated, targetoid Michaelis-Gutmann bodies resembling Von Hansemann cells in malakoplakia. Histopathology confirmed the diagnosis of malakoplakia of bone. CONCLUSION This case, histologically proven to be malakoplakia, demonstrated regression of the lesion following therapy. The characteristic cytologic features and presence of Von Hansemann cells may in themselves be diagnostic and obviate the need for biopsy.

A cytohistological study of Ki-67 expression in ovarian tumors.

BACKGROUND AND OBJECTIVE The study was conducted to evaluate the diagnostic accuracy of imprint cytology in ovarian neoplasms, and to investigate the biological significance of Ki-67 antigen expression in benign and malignant ovarian tumors and correlate it with histological type, grade, and stage of malignant tumor. MATERIALS AND METHODS A total of 50 cases including 25 prospective and 25 retrospective cases were studied. Imprint cytology was performed on 25 ovarian tumors and compared with histopathological diagnosis. Ki-67 immunohistochemistry was performed on all 50 cases. RESULTS On immunohistochemistry, benign tumors had a mean Ki-67 index of 3.2 ± 3.7 while malignant tumors had a mean Ki-67 index of 33.1 ± 16.7, the difference being statistically significant. Significant correlation was observed between the Ki-67 index and stage of the tumor; however, there was no correlation between the grade of differentiation and histological type of tumor with the Ki-67 index. CONCLUSIONS In the present study, the Ki-67 index was higher in advanced stage tumors; hence a higher Ki-67 index points toward the aggressive behavior and poorer clinical outcomes.