Raghunandan Prasad

Cytomorphological Features of Medullary Thyroid Carcinoma: An Analysis based on 41 Ultrasoundguided Fine-needle Aspiration Specimens

Introduction: Medullary thyroid carcinoma (MTC) is a malignant tumor of thyroid gland showing parafollicular or C-cell differentiation. Aims and objectives: The current study was undertaken to evaluate safety of ultrasound-guided thyroid fine-needle aspiration cytology (FNAC) and to assess cytomorphological features of MTC in FNA specimens from 28 patients. Materials and methods: The study was performed by retrospectively reviewing the clinical and pathological records of MTC cases managed at our institute. Results: The patients included 18 males and 10 females with a mean age of 45.3 years; 24 specimens were taken from thyroid, 15 from cervical lymph nodes and one each from liver space occupying lesion and chest wall nodule. There was no complication noted during ultrasound-guided FNAC in these patients. The smears had variable cellularity in the form of moderate cellularity in 63% of specimens and low cellularity in 15% of specimens. Cell arrangements were solid cohesive in 39% of cases and microfollicular clusters in 36% of cases. The frequent microfollicles in two specimens prompted the differential of follicular carcinoma. Dispersed population was noted in 90% of specimens. Binucleated and multinucleated cells were seen in 58 and 53% specimens respectively. Only spindle cell morphology was noted in 2% of specimens. Central 1,4,8Additional Professor, 2,5,7Assistant Professor, 3Demonstrator 6Senior Resident, 9Professor 1Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India 2,4Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India 3Department of Pathology, FH Medical College and Hospital Agra, Uttar Pradesh, India 5Department of Pathology, King George’s Medical University Lucknow, Uttar Pradesh, India 6Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India 7-9Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India Corresponding Author: Raghunandan Prasad, Assistant Professor, Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, e-mail: coolraghu2001@gmail.com ORIGINAL ARTICLE 10.5005/jp-journals-10002-1229 wjOEs to eccentric nuclei were present in 39% of specimens, while 13% of specimens showed mainly eccentric nuclei. In all the specimens, neuroendocrine type of salt and pepper-like morphology was present which is best seen with Papanicolaou (Pap) stain. Similarly, cytoplasm showed granules in 78% and fine vacuoles in 29% of specimens. Amyloid appreciated as flecks or aggregates of amorphous pink or gray color was seen in 37% of specimens. No mitosis was noted in any specimen, while necrosis was seen in only in one specimen. Conclusion: Ultrasound-guided FNAC is a fairly accurate, relatively safe, rapid, and simple tool for preoperative diagnosis of thyroid malignancies. Although the cytological features of MTC are well described, different patterns may pose a diagnostic difficulty.

Pseudoaneurysm of superior epigastric artery branch: A rare complication following renal allograft biopsy treated by percutaneous thrombin injection

Renal biopsy is often needed to diagnose posttransplant graft dysfunction. Although it is very safe due to availability of real-time imaging, complications do occur. We report a rare case of anterior abdominal wall vessel injury during allograft biopsy resulting in a large perigraft hematoma. It mimics a subcapsular hematoma due to intrarenal vessel injury leading to diagnostic confusion. We detected a partially thrombosed pseudoaneurysm 3 weeks after the biopsy which had feeders from superior and inferior epigastric artery confirmed by injecting contrast into the pseudoaneurysm. The pseudoaneurysm is due to injury to small branch of these arteries. We used a novel and a cost-effective therapeutic intervention to treat this pseudoaneurysm. We injected thrombin percutaneously into pseudoaneurysm which enables thrombosis of the feeder vessels preventing recurrence.

Imaging features of pulmonary infection in post renal transplant recipients: A review

The renal transplant recipients are prone to the variety of infectious pathogens. The HRCT features could provide valuable information for differentiation diagnosis and treatment response. Findings in renal transplant recipients with manifestations of immune-compromised-related pulmonary diseases could be either pathogen-specific or -non-specific. It is particularly fundamental to recognize these imaging characteristics at suspicion of opportunistic infections in such patients. In this article, we present a review to refresh and update our knowledge of HRCT features of pulmonary infectious diseases in immune-compromised patients.

Isolated empyema necessitans in a renal transplant recipient: A case report

Empyema necessitans is a rare sequel of untreated pleural space infection and is most commonly secondary to tuberculosis. Isolated tuberculous empyema necessitans in a renal transplant recipient is extremely rare. It is an important differential diagnosis of a chest mass in renal transplant recipient. Early identification and treatment prevents progression and morbidity. We hereby report a 62-year-old male renal transplant recipient who presented with classical features of tubercular empyema necessitans and was managed with antitubercular therapy and tube thoracostomy drainage.