Reeni Malik

Skeletal angiomatosis - rare cause of bone destruction: a case report with review of literature.

Classification of skeletal angiomatosis into aggressive and nonaggressive types is on the basis of their clinical behavior and pattern of skeletal involvement (regional and disseminated). Gorhams disease (massive osteolysis) is an aggressive form of skeletal angiomatosis that shows regional involvement, frequently involving the shoulder and hip areas. Cystic angiomatosis is a nonaggressive form of skeletal angiomatosis with multifocal involvement, predominantly affecting the trunk bones. The imaging modalities gave the diagnosis of cystic angiomatosis of humerus showing multicystic lytic areas. The histopathological differential diagnosis was cystic angiomatosis and Gorhams disease, as microscopically both are indistinguishable from each other. Both represent a complex network of dilated thin-walled capillaries growing in the marrow space associated with the destruction of bone and infiltration into the adjacent soft tissues. The case is presented because of its extreme rarity and due to the diagnostic dilemma, whether to label it as Gorhams disease or as cystic angiomatosis. Considering the site involved and its aggressiveness, the diagnosis is in favor of Gorhams vanishing bone disease as cystic angiomatosis is multicentric and nonaggressive, involving mostly vertebrae and skull with multicystic lytic lesions.

Cytomorphological variables of hepatic malignancies in fine needle aspiration smears with special reference to grading of hepatocellular carcinoma

Background: The evaluation and management of discrete hepatic masses is a clinical problem. Ultrasound guided fine needle aspiration cytology (FNAC) is a rapid, accurate and safe diagnostic procedure that can be used in various neoplastic and non-neoplastic diseases of the liver. Aim: To evaluate the cytomorphological features of hepatocellular carcinoma. Materials and Methods: Ultrasound-guided fine needle aspiration was performed on 52 patients clinically suspected of having hepatic lesion. Results: Malignancy was detected in 50 cases. The primary malignancies consisted of 15 cases of hepatocellular carcinoma (HCC), 4 cases of cholangiocarcinoma and 2 of hepatoblastoma. There were 29 metastatic lesions, which included 26 cases of adenocarcinoma, 2 cases of squamous cell carcinoma and 1 of lymphoma. The key diagnostic features for HCC were trabecular arrangement, polygonal cells with eosinophilic and granular cytoplasm, hyperchromatic nuclei with macronucleoli. Atypical naked hepatocytic nuclei and malignant cells separated by sinusoidal capillaries were also commonly seen. The sensitivity and specificity of FNA for malignancies was found to be 96% and 100% respectively, yielding a positive predictive value of 100% and negative predictive value of 50%. Conclusions: There was a very good correlation of cytological criteria and histopathological diagnosis in hepatocellular carcinoma of various grades as well as in differentiating primary from metastatic tumors. It is recommended that image directed FNAC should be the primary diagnostic modality for assessing potential malignancy in any patient with a localized hepatic mass.

Cytological assessment of endometrial washings obtained with an insemination cannula and its histological correlation

Background: Endometrial cytopathology is a powerful tool for the detection of a wide variety of benign atypias, inflammatory changes, and infectious organisms. It is also helpful for the cytohormonal evaluation of patients and the detection of endometrial malignancies. Aims: The present study was carried out to assess the sensitivity and specificity of endometrial cytology performed by using an insemination cannula. Materials and Methods: Endometrial aspiration using an insemination cannula was done in 60 cases who presented with dysuterine bleed, infertility, or postmenopausal bleed. The cytological evaluation of endometrial smears was correlated with histopathological findings with reference to cyclic endometrium, atypical hyperplasia, and endometrial malignancies. Results: There were 35 patients in the reproductive and 25 in the menopausal age groups. The sample was inadequate in four cases but there was an overall 100% correlation between cytological and histological findings of cyclic endometrium, atypical hyperplasia, and endometrial malignancy. The sensitivity and specificity of endometrial aspiration was 83.3 and 95.4% respectively, with two false negative and false positive cases. Conclusions: Endometrial aspiration cytology was found to be a safe outpatient procedure in the diagnosis of normal and abnormal endometrium for patients of all ages.The present study emphasizes the need for endometrial screening in postmenopausal patients to enable the detection of endometrial malignancies at an early stage.