Pranab Dey

Micronucleus and its applications

Micronucleus (MN) is a small additional nucleus and is readily identifiable by light microscopy. Biologically, micronuclei are the chromosome fragments or whole chromosomes that lag behind at anaphase during nuclear division. MN occurs due to genetic damage of the cell and the MN scoring is the indicator of the genetic damage. Therefore MN scoring can be used in various clinical setting such as to supervise genotoxicity, biomonitoring of diseases, screening of preneoplastic diseases and identification of high risk patients. In this brief review, the morphology, etiology, estimation, and applications of MN have been discussed. Diagn. Cytopathol. 2012.

Cancer nucleus: morphology and beyond.

There are many significant morphological alterations of a nucleus of cancer cell that are detectable by light microscopy on routine staining. These changes are often associated with deranged cellular functions of cancer cell. It is difficult to understand the exact relationship between nuclear morphology and alteration of nuclear structural organization in cancer. Herein, the salient visual and subvisual morphological changes of cancer nuclei and their possible etiology and significance have been reviewed. Diagn. Cytopathol. 2010.

Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours and tumour‐like lesions

In this study, we evaluated the usefulness of fine needle aspiration cytology (FNAC) in the diagnosis of soft tissue tumours. We have also assessed the various pitfalls of FNAC of soft tissue tumours. This was a retrospective study and here we analysed only 82 histopathology proven cases of FNAC of soft tissue tumours diagnosed in a five and half year period. On histopathological examination, 55 of these cases were malignant and 27 were benign. There was a total of 15 recurrences and histopathology was available prior to FNAC in only eight of these cases. Therefore, excluding these eight cases, malignant tumours were primarily diagnosed by FNAC in 47 cases. The sensitivity, specificity and positive predictive value of FNAC in diagnosis of soft tissue tumours were 91.5%, 92.5% and 95.5%, respectively. Only 22 of 47 cases (46.8%) were correctly categorized. There were two false‐positive and four false‐negative cases. One case each of fibromatosis and schwannoma were reported as sarcoma. False‐negative cases were fibrosarcoma (1), malignant nerve sheath tumour (2) and haemangiopericytoma (1). FNAC was very useful in distinguishing benign from malignant soft tissue tumours. However, it was not so effective in exact categorization of tumours.

Malignant atypical cell in urine cytology: a diagnostic dilemma

Aims The aim of this study was to find out the characteristic morphology of malignant atypical cells which were missed on routine cytology of urine. Materials and methods In this retrospective study, we examined detailed cytomorphology of 18 cases of atypical urinary cytology which were missed on routine examination and were further proved on histopathology as transitional cell carcinoma (TCC) of bladder. The cytological features of these cases were compared with 10 cases of benign urine samples. Results There were 11 cases of high grade TCC and 7 cases of low grade TCC on histopathology of the atypical urine samples. Necrosis in the background and necrosed papillae were mostly seen in malignant atypical cells. The comet cells and cells with India ink nuclei (single cells with deep black structure-less nuclei) were only observed in malignant atypical cells. The most consistent features in malignant atypical cells were: i) high nuclear and cytoplasmic (N/C) ratio ii) nuclear pleomorphism iii) nuclear margin irregularity iv) hyperchromasia and v) chromatin abnormalities Conclusion The present study emphasizes that nuclear features such as high N/C ratio, hyperchromasia and chromatin abnormalities are particularly useful for assessing the malignant atypical cells. Other cytological features such as comet cells and cells with India ink nuclei are also helpful for diagnosis but have limited value because they are less frequently seen.

Cell cannibalism and cancer

Cellular cannibalism, defined as a large cell enclosing a slightly smaller one within its cytoplasm. In this review, we discussed the morphology, possible mechanism, and the cytological significance of cannibalism in relation to malignancy. Cannibalism is a completely different entity than phagocyosis, entosis, and emeriopoliosis. It is an important morphologic feature to distinguish benign from malignant lesions. Cannibalism has been described in various cancers such as, bladder cancer, breast cancer, lung cancer, etc, and this is related with the aggressiveness of the malignancy. Diagn. Cytopathol.2011;39:229–233.

Cytology of Primary Skin Tumors

OBJECTIVE To evaluate the role of fine needle aspiration biopsy (FNAB) in the diagnosis of primary skin and adnexal tumors and to study the cytomorphology of various primary skin and adnexal tumors. STUDY DESIGN FNAB was routinely done in 18 cases of skin and adnexal tumors, and the cytologic diagnosis, along with detailed cytomorphology, was correlated with subsequent histology. RESULTS FNAB was done on 15 cases of primary skin tumors and 3 cases of recurrent lesions. FNAB successfully established the benign or malignant nature of skin tumors in 16 of 18 cases (88.9%). However, subtyping was possible in only 12 of 18 cases (66.7%). CONCLUSION Clinical history and physical findings are essential to the proper diagnosis of adnexal tumors. Knowing the cytologic features of primary skin neoplasms helps distinguish them from tumors metastatic to the skin and more commonly referred for FNAB.

Fine Needle Aspiration Cytology in Lymphadenopathy of HIV-Positive Cases

OBJECTIVE To evaluate the role of fine needle aspiration biopsy (FNAB) material in 25 HIV-positive cases with lymphadenopathy. STUDY DESIGN We selected 25 cases for the present study who were enzyme-linked immunosorbent assay positive for HIV (HIV-1). FNAB was performed as a routine, outdoor procedure with informed consent of the patient. For each case, along with routine May-Grünwald-Giemsa and hematoxylin and eosin staining, Ziehl-Neelsen staining for acid-fast bacilli and periodic acid-Schiff staining for fungi were performed wherever necessary. RESULTS A total of 28 sites were aspirated from 25 HIV patients. All these patients were heterosexual, and none had a history of drug abuse. FNAB was performed under ultrasound guidance in all four cases of a retroperitoneal group of lymph nodes. The most common FNAB diagnosis was reactive lymphoid hyperplasia (10), followed by tuberculosis (8). There were three cases diagnosed as fungal infection (two, Cryptococcus; one, histoplasmosis). FNAB of a case of lymph node was suggestive of tuberculosis. There was one case each diagnosed as non-Hodgkins lymphoma and squamous cell carcinoma (metastatic). One case of a small axillary lymph node did not yield representative material. CONCLUSION FNAB is a relatively inexpensive initial investigative technique in the diagnosis and management of HIV-positive patients. It can obviate the need for surgical excision and enable immediate treatment of specific infections.

Fine needle aspiration cytology of follicular variant of papillary carcinoma of thyroid

In this retrospective study, we tried to ascertain the fine needle aspiration cytology (FNAC) features of six histopathologically proven cases of the follicular variant of papillary carcinoma of thyroid (FVPCT). These proven cases were diagnosed from 1998–2000. May–Grunwald–Giemsa and haematoxylin & eosin stained FNAC smears were studied independently by two observers (MP and PD) for detailed cytological features. A comparison of the cytological features was undertaken with those reported in the literature. There were six cases of which only one case was diagnosed as FVPCT while the other five cases were diagnosed as follicular neoplasm (four cases) and neoplasm unclassifiable (one case) on FNAC smears. All these cases showed abundant cellularity with a prominent follicular pattern. No papillae were identified in any of the cases. Syncytial clusters (five cases), nuclear grooves (six cases), nuclear inclusions (one case) and chewing gum colloid (three cases) were noted in variable proportions. We suggest that a differential diagnosis of FVPCT should be considered if the cytology smears show abundant cellularity, syncytial clusters and follicular arrangement along with thick colloid.

Combined applications of fine needle aspiration cytology and Flow cytometric immunphenotyping for diagnosis and classification of non Hodgkin Lymphoma

Aims and objectives In this present study we have evaluated the feasibility of sub-classification of non-Hodgkins lymphoma (NHL) cases according to World Health Organizations (WHO) classification on fine needle aspiration cytology (FNAC) material along with flow cytometric immunotyping (FCI) as an adjunct. Materials and methods In this five years study, only cases suggested or confirmed as NHL by FNAC were selected and FCI was performed with a complete panel of antibodies (CD3, CD2, CD 4, CD5, CD8, CD7, CD10, CD19, CD20, CD23, CD45, κ and λ) by dual color flow cytometry. Both cytologic findings and FCI data were interpreted together to diagnose and sub-classify NHL according to WHO classification. Wherever possible the diagnoses were compared with cytology. Results There were total 48 cases included in this study. The cases were classified on FNAC as predominant small cells (12), mixed small and large cells (5) and large cells (26). In five cases a suggestion of NHL was offered on FNAC material and these cases were labeled as NHL not otherwise specified (NHL-NOS). Flow cytometry could be performed in 45 cases (93.8%) and in rest of the three cases the material was inadequate because of scanty blood mixed aspirate. Light chain restriction was demonstrated in 30 cases out of 40 cases of B-NHL (75%). There were 15 cases each of κ and λ light chain restriction in these 30 cases. With the help of combined FCI and FNAC, it was possible to sub-classify 38 cases of NHL (79%) according to WHO classification. Combined FNAC and FCI data helped to diagnose 9 cases of small lymphocytic lymphoma (SLL), 2 cases of mantle cell lymphoma (MCL), 4 cases of follicular lymphoma (FL), 17 cases of diffuse large B lymphoma (DLBL) and 6 cases of lymphoblastic lymphoma. Histopathology diagnosis was available in 31 cases of NHL out of which there were 14 recurrent and 17 cases of primary NHL. Out of 15 DLBL cases diagnosed on FCI and FNAC, histology confirmed 14 cases and one of these cases was diagnosed as Burkitts lymphoma on histology. Cases of FL (4), SLL (3) and MCL (2) were well correlated with histopathology. Out of the five cases suggestive of NHL on cytology, histopathology was available in four cases. Histology diagnosis was given as DLBL (1), SLL (1), anaplastic large cell lymphoma (1) and FL transformed into large cell NHL (1). Considering histopathology as gold standard, diagnostic specificity of combined FNAC and FCI was 100% (31/31) and sensitivity in sub-classification was 83.8% (26/31). Conclusion FNAC combined with FCI may be helpful in accurately sub-classifying NHL according to WHO classification. Many of the subtypes of NHL such as FL and MCL which were previously recognized as a pure morphologic entity can be diagnosed by combined use of FNAC and FCI. Other ancillary investigations such as chromosomal changes, cell proliferation markers etc. may be helpful in this aspect.

Expression of cytokeratin 20 in urine cytology smears: a potential marker for the detection of urothelial carcinoma

Background:  Urine cytomorphology is one of the oldest methods for screening and monitoring patients with transitional cell carcinoma (TCC). Sensitivity of urine cytology is relatively low. Ancillary techniques on urine sample may increase the sensitivity.