Nilanjana Ghosh

Oncocytic lesion of parotid gland: A dilemma for cytopathologists

Oncocytes are epithelial cells with abundant, granular, eosinophilic cytoplasm due to presence of numerous large mitochondria of varied sizes. The presence of oncocytes in salivary glands can occur in a variety of conditions. Here, we present a rare case of a 68 year old male patient who presented with a 6 cm diameter swelling in the right parotid region. A fine needle aspiration cytology done from the lesion showed a cellular oncocytic lesion. A possibility of oncocytoma was entertained. Histopathology of the mass showed a rare entity called diffuse hyperplastic oncocytosis. Originally believed to be a metaplastic process, oncocytes can occur in various lesions ranging from hyperplastic conditions to malignant neoplasms. However, diagnosis on cytological smears can be very challenging for the cytopathologist.

A clinicopathological study of tuberculous pleural effusion in a tertiary care hospital

Context: Tuberculosis is a major contributor of exudative pleural effusion which is the second most common extra-pulmonary manifestation of tuberculosis following tubercular lymphadenitis. Aims: To re-evaluate the time tested and easily available investigation of closed pleural biopsy and its relation with pleural fluid adenosine deaminase (ADA) level and cytological findings in the clinically suspected cases of tuberculous pleural effusion. Materials and Methods: A total of 44 cases of suspected tubercular pleural effusion were selected from the indoor ward of a tertiary care hospital, over a period of 13 months. Apart from the relevant history taking and clinical examination, thorough investigations were done in each case to prove the etiological diagnosis, which comprised of routine hemogram, bleeding time, clotting time, Mantoux test, sputum microscopy, enzyme-linked immunosorbent assay (ELISA) for HIV, chest X-ray, examination of pleural fluid including ADA estimation, culture for Mycobacterium tuberculosis (BACTEC), and finally, pleural biopsy by Abrams needle. Results: A total of 65.8% cases of tuberculous pleural effusion were diagnosed by pleural biopsy results. Second biopsy attempts improved the diagnostic ability by 18.4%. The highest incidence was observed in the 11-20 years age group (36.8%). Chest pain (86.8%) was the predominant symptom. Positive Tuberculin skin test was observed in 89.5% cases. Pleural fluid analysis showed a predominance of lymphocytes in all the cases, with 97.3% patients having ADA levels > 70 U/L. There was no major complication of pleural biopsy. Conclusions: Pleural biopsy is a very important tool for diagnosing tuberculous pleural effusion without any major complication. ADA values > 70 U/L are highly suggestive of tubercular etiology and correlated well with histopathological findings of pleural biopsy.

Factors affecting the healthcare-seeking behavior of mothers regarding their children in a rural community of Darjeeling district, West Bengal

Background : An ailing, unresponsive health system and the existing social complexities, with considerable contextual differences, are all pervasive in India. In health, these are manifested as differences in morbidity and mortality, severely affecting child health and survival. Objectives: To find out the possible factors affecting the health-seeking behavior of mothers with regard to their children, in a rural community of Darjeeling district, and the reasons for not seeking curative care for perceived sick children. Materials and Methods: A cross-sectional, community-based study among the mothers of the Naxalbari Block was undertaken, using a multistage random sampling technique, from June to August 2011, by using the questionnaire method. A total of 256 mothers (sample size) were studied. Results: Joint family structure, mass media exposure, literacy status, socioeconomic status of mothers, and gender differences among children were found to be significantly associated with the healthcare-seeking behavior of the mothers. Conclusion: Increasing maternal education, intensified awareness generation through the mass media approach, implementing gender-sensitive interventions, and counseling, may have positive implications in future, leading to better health outcomes and favorable health indicators.

Giant adrenal myelolipoma with hemorrhage masquerading as retroperitoneal sarcoma

Adrenal myelolipomas are functionally inactive, rare adrenal tumors which are usually small in size and are discovered incidentally. Giant symptomatic myelolipomas have rarely been reported in medical literature. Here, we describe the case of a 40-year-old female patient who presented to the surgical outpatient department with left flank pain. An ultrasonogram of the abdomen suggested a large retroperitoneal tumor which was then surgically resected. Histopathological examination of the resected specimen revealed a giant adrenal myelolipoma with intratumoral hemorrhage. The patient was relieved of symptoms and was free of any complaints in follow-up.

Cytohistopathological correlation of a case of squamous cell carcinoma of gallbladder with lymph node metastasis.

Primary carcinomas of the gallbladder are rare malignancies and adenocarcinoma is the more common subtype. Primary squamous cell carcinoma of the gallbladder has rarely been diagnosed by aspiration cytology. Here, we present a case of a 62-year old female patient suffering from abdominal complaints who underwent ultrasound-guided fine-needle aspiration cytology and was diagnosed as keratinizing squamous cell carcinoma of gallbladder. The diagnosis was confirmed on subsequent histopathological examination that also revealed metastasis in the cystic lymph node. Histogenesis and biological behavior of squamous cell carcinoma of gallbladder remains a matter of debate but the role of aspiration cytology in diagnosing these lesions cannot be undermined.

Computed tomography guided fine needle aspiration cytology of mass lesions of lung: Our experience

Context: Computerized tomography (CT) guided fine needle aspiration cytology (FNAC) of lung lesions has rapidly emerged as a less-invasive, cheap, rapid and fairly accurate diagnostic aid in lung lesions. Aims: The purpose of this present study was to evaluate the effectiveness of CT-guided FNAC in the diagnosis of pulmonary mass lesions (both benign and malignant) and to determine the complication rate of this procedure. Settings and Design: We conducted an institution-based, prospective study on 127 patients who presented with pulmonary mass lesions. Materials and Methods: After proper consent was obtained, CT-guided transthoracic fine needle aspiration was done and their diagnoses were confirmed by appropriate methods. The results were analyzed statistically. Results: Out of 127 cases selected for the study, 59.8% were males while the rest were females. Cough was the most common symptom present in 71.2% cases, followed by weight loss (62.4%). 21.2% cases were cytologically benign. Adenocarcinoma (54.2%) was the commonest malignant tumor. FNAC provided at least 96% sensitivity and 100% specificity in diagnosing lung tumors. Among the benign lesions, specific diagnoses were obtained in 48.1% cases. Thus, altogether a specific diagnosis was obtained in 109 of 127 cases, i.e. 85.8%. No major complication was noted. Conclusions: CT-guided FNAC is an extremely valuable and fairly accurate diagnostic aid of intrathoracic mass lesions, with a reasonable rate of complication.

Post-salpingectomy endometriosis: An under-recognized entity

We report a case of a 48-year old lady, who presented with complaints of lower abdominal pain and menorrhagia for the last four months. The patient had undergone bilateral salpingectomy four years back by the Pomeroy technique. Ultrasonography revealed an ovarian cyst on the right side. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed and the specimen was sent for histopathological examination. It revealed that the normal mucosa of the tubectomy stump was completely replaced by endometrial tissue. Tubal endometriosis remains an under-recognized entity, due to less extensive routine sampling of the fallopian tubes, and they may be also be associated with other pathologies, as was in the present case.

Trend and pattern of various types of cancer with special reference to gall bladder cancer in North Bengal medical college, West Bengal, India: A 3 years record based study

Background: Global burden of cancer is on rise and trends and pattern of cancers are rapidly changing different geographic and population groups. Gall bladder cancers are emerging with increasing proportion among select areas and groups and understanding these variations are important for appropriate strategies and interventions. However, absence of a well-developed universal cancer registry system in India, institution based secondary data analysis can generate useful information. The present study was conducted to determine the trend and pattern of cancer cases (with special reference to gall bladder cancer) treated in a tertiary care hospital in northern part of West Bengal. Methods: Record based cross-sectional study was conducted in Department of Radiotherapy, North Bengal Medical College and Hospital. All newly registered cases between (2010 and 2012) were reviewed. Results: A total of 2058 cancer cases were recorded during the 3-year period. Of these, major types of cancers were oro-pharynx (16.1%), breast (15.4%), cervix (13.2%), lung (12.7%), gall bladder (6.5%) stomach cancer (6.4%), etc., Increasing proportions was observed for breast and gall bladder cancers. The proportion of gallbladder cancer cases in 2010, 2011, and 2012 were 3.8%, 7.3% and 7.8%, respectively. Among 134 gall bladder cancer cases, 93.3% were females, 85.1% alcoholics, 57.4% had a history of fatty liver, 94% had adeno/adenosquamous carcinomas, and 65.7% were metastatic in nature. Conclusions: Increasing trend is observed in gall bladder cancer cases emphasizing the need for further large scale studies.

Cytologic diagnosis of undifferentiated high grade pleomorphic sarcoma of breast presenting with brain metastasis

Primary sarcoma of breast are rare. Diagnosis by aspiration cytology is difficult due to nonspecific cytomorphologic features. An initial presentation with neurological symptoms due to metastasis of breast sarcoma to the brain has not been previously reported. Here, we describe a case of a 60-year-old female who presented with headache, dizziness and convulsion and was subsequently diagnosed with undifferentiated high grade pleomorphic sarcoma of breast with cerebellar metastasis.

A community based pilot study on prevalence of hemoglobinopathies among the antenatal women in a rural area of Darjeeling district, West Bengal.

Background: Hemoglobinopathies comprising of thalassemias and various hemoglobin (Hb) variants continue to plague the health system of India. Aims: To find out the prevalence of various hemoglobinopathies in the study population and to identify any association with the various ethnic groups residing in rural community of Darjeeling district, West Bengal. Materials and Methods: A community-based cross-sectional study was conducted in Naxalbari block of Darjeeling district, West Bengal from June 2011 to August 2011, involving hemoglobin variant screening by high-performance liquid chromatography (HPLC) method of 188 antenatal women, selected through multistage random sampling technique. Results: 26.6% of mothers had abnormal hemoglobin, the commonest being the Hemoglobin E (Hb E) trait (15.42%). The prevalence of homozygous HbE, HbE βthalassemia, β-thalassemia trait and hemoglobin S-trait in the studied population was 6.91%, 0.53%, 2.12% and 1.06% respectively. There was a single case of the rare hemoglobin J Meerut. Among those having abnormal hemoglobin, 66% belonged to one ethnic group, Rajbanshis. A statistically significant association was noted between Hb E syndrome (comprising of HbE trait, homozygous HbE, HbE-betathalassemia) and Rajbanshis ( P Conclusion: Findings suggest a high prevalence of hemoglobinopathies particularly Hb E in the studied population, especially Rajbanshis and warrant the need of wider community-based initiative for carrier detection and awareness generation.