Nisha Jayashankar Marla

Primary umbilical endometriosis - Diagnosis by fine needle aspiration

Primary (spontaneous) umbilical endometriosis is very rare with an estimated incidence of 0.5-1% of all patients with endometrial ectopia. Endometriosis is a common gynecological condition, the pelvis being the most common site of the disease. Extrapelvic site is less common and even more difficult to diagnose due to the extreme variability in presentation. A 38-year-old woman presented with a blackish nodule over the umbilicus of 3 years duration. Fine needle aspiration cytology of the lesion showed cells in clusters and sheets with background of scant stromal fragment, hemosiderin laden macrophages and RBCs, leading to a suggestion of umbilical endometriosis. Histopathological examination of the excised lesion confirmed the same.

Cytodiagnosis of actinomycetoma

Mycetoma is a late clinical manifestation of a subcutaneous infection produced by bacteria (actinomycetoma) or fungi (eumycetoma). The distinction between eumycetoma and actinomycetoma in Fine Needle Aspiration Cytology (FNAC) is as accurate as histopathology. A 55 year old man presented with a slow growing swelling on the plantar aspect of the right foot which was present for the last 10 years. A clinical diagnosis of soft tissue tumor was made and FNAC was advised. Smears revealed mixed inflammatory infiltrate and foreign body type of giant cells along with clumps of fibrillar organisms. Gram stain done later demonstrated gram positive thin branching filaments. A diagnosis of actinomycetoma was rendered. Histopathology of the excised specimen confirmed the cytologic diagnosis of actinomycetoma. Mycetoma can be accurately diagnosed by FNAC, which is a simple, inexpensive technique for rapid diagnosis. Diagn. Cytopathol. 2009.

Giant Solitary Fibrous Tumor of the Pleura (SFTPs) associated with paraneoplastic Doege Potter Syndrome

SFTPs are uncommon spindle cell mesenchymal tumors. These tumors arise in pleural as well as in extra pleural sites like liver, orbit, lung, nasal passages, meninges, respiratory tract, thyroid, soft tissues, major salivary glands, kidney, periosteum and spinal cord. SFTPs of thorax are interesting in that they can present with mass effect and paraneoplastic syndrome. Doege Potter Syndrome that is Giant SFTP presenting as hypoglycemic coma is an exceptional presentation of SFTPs. SFTPs are often mistaken for epithelial mesotheliomas. Positivity for vimentin, a marker of mesenchymal cells, negativity for cytoplasmic keratin which is positive in mesotheliomas and expression of Clusters of Differentiation (CD) 34 antigens can confirm the presence of a SFTP. Ultra structural studies further support the fibroblastic nature of these tumors. We hereby report an exceptional case of a 50-year-old lady with giant SFTP presenting with hypoglycemic coma. A diagnostic as well as therapeutic thoracotomy with complete surgical resection of the tumor was performed with complete relief of symptoms.

Fine needle aspiration cytology of male breast lesions - a retrospective study over a six year period.

BACKGROUND Fine needle aspiration cytology (FNAC) has a well-established role in the management of palpable breast lumps. However breast masses in males are rarely aspirated and hence there is limited cytopathologic experience. The aim of our study was to determine the efficacy of FNAC in the diagnosis of male breast lesions and also we attempted to describe the cytomorphological features of some of these lesions. MATERIALS AND METHODS Data on male breast FNAC done between 2008 to 2013 were retrieved from the records of the cytopathology laboratory. FNAC diagnosis were categorized as benign, malignant, suspicious for malignancy and inadequate or unsatisfactory. Cytohistologic correlation was done with data from histopathology records. Sensitivity, specificity and diagnostic accuracy were calculated using standard statistical methods. RESULTS Forty out of 1098 patients undergoing breast FNAC were males. Histopathology was available in 8 (20%) out of 40 cases. There were no false positive or false negative diagnoses. FNAC had a sensitivity, specificity and diagnostic accuracy of 100% for male breast lesions. CONCLUSION FNAC is a very accurate tool for the diagnosis of male breast lesions. It is highly sensitive and specific with good cytohistologic correlation. To reduce the high rate of surgical biopsies of benign male breast masses, we conclude that FNAC should be performed as a standard procedure in the clinical evaluation of male breast lesions.

Cytodiagnosis of Castleman's disease: A diagnostic challenge

Castleman′s disease (CD) is an uncommon cause of solitary or multiple lymphadenopathy, which may be a target for fine-needle aspiration (FNA). Because of its rarity and lack of adequate literature available on its cytomorphological findings, the condition is misdiagnosed or missed out during routine FNA reporting. The presence of small lymphocytes and plasma cells with large atypical binucleate follicular dendritic cells resembling Reed-Sternberg cells may raise a suspicion of Hodgkin lymphoma (HL). Here, we report the cytodiagnosis and pitfalls in the diagnosis of CD in three cases. FNA smears were reviewed and pitfalls in the diagnosis analyzed and correlated with histopathological findings.

Solitary neurofibroma of the inferior orbit: A rare occurrence

Solitary neurofibroma in the absence of neurofibromatosis is of rare occurrence and very few have been reported in the literature till now especially in the inferior orbit. A case of solitary neurofibroma of the inferior orbit is presented here. 32 year old male patient presented to us with history of swelling below the left lower lid since 2 years. After the detailed clinical and radiological examination patient underwent anterior orbitotomy and excision of the mass. Histopathological examination confirmed the diagnosis of neurofibroma of the inferior orbit which is of very rare occurrence.

A clinicohematological evaluation of pancytopenia in a tertiary care hospital in South India

Objective: The aim of this study is to study the incidence of the underlying etiology of pancytopenia presenting at our institution with a clinical and hematological correlation. Materials and Methods: A prospective study of 12 months′ duration was carried out, which included patients of all age groups. Of the 60 patients presenting with pancytopenia, bone marrow aspiration and biopsy were done on 30 cases, after taking an informed consent. Patients who had received previous blood transfusion and were on chemo- and radiotherapy were excluded. A detailed clinical examination of all cases was carried out. Results: The most common etiology of pancytopenia in our study was normoblastic erythroid hyperplasia (30%), followed by megaloblastic anemia (20%). This was followed by acute myeloid leukemia (13.3%) and closely by micronormoblastic erythroid maturation (10%) and miscellaneous etiologies. Conclusion: The varied causes of pancytopenia can be attributed to the geographic area, genetic differences, stringency of diagnostic criteria, and differences in the methodology used. There are varying trends in its clinical pattern, treatment modalities, and outcomes. The severity of pancytopenia and the underlying pathology determines the management and prognosis. Thus, identification of the correct cause will help in implementing the appropriate therapy.