Roobina Khan

Mammary tuberculosis : Analysis of thirty-eight patients

Thirty‐eight patients with mammary gland tuberculosis were evaluated over a 5‐year period presenting to the surgical unit of our institution. Unilateral involvement of the breast in a woman presenting at an average age of 29 years was the commonest observation. A lump in the breast with or without discharging sinuses was the most common clinical presentation. Ten (26%) of these patients had breast pain with or without increased breast nodularity. Axillary lymph nodal involvement was evident in 14 (36%) of our patients. Only five patients had associated pulmonary tuberculosis, the rest having an isolated involvement of the breast. Fine‐needle aspiration cytology was the most reliable diagnostic modality. Medical therapy with antitubercular drugs ranging from 6 to 9 months was the mainstay of treatment. Surgical intervention was reserved for selected refractory cases.

Cervical lymphadenopathy: scrofula revisited.

BACKGROUND The commonest form of extrapulmonary tuberculosis is tubercular cervical lymphadenitis, or scrofula. METHODS AND RESULTS A total of 1827 patients with cervical lymphadenopathy who presented to various out-patients clinics of our institution were studied over a three-year period. Eight hundred and ninety-three (48.87 per cent) of these patients had lesions of tubercular origin. The most common observation was unilateral, matted adenopathy in female patients aged between 11 and 20 years and without constitutional symptoms of tuberculosis. Posterior triangle nodes were affected in 43.8 per cent of cases, followed by upper deep cervical nodes in 33.9 per cent. Fine needle aspiration cytology constituted the main diagnostic tool, with a positive yield in 90 per cent of patients. Polymerase chain reaction analysis was performed in 126 patients, with a sensitivity of 63 per cent. Only 18 per cent of patients had associated pulmonary tuberculosis, the rest having isolated involvement of cervical nodes. Medical treatment with anti-tubercular drugs for a period of six months formed the mainstay of treatment and cure. Surgical management was reserved for selected refractory patients. CONCLUSION Tubercular cervical lymphadenitis can readily be diagnosed by fine needle aspiration cytology, a simple and cost-effective test. The disease can be cured completely by a short course of anti-tubercular chemotherapy, without surgical intervention.

The value of fine-needle aspiration cytology in the evaluation of pediatric head and neck tumors

OBJECTIVE To study the efficacy of fine-needle aspiration cytology (FNAC) of head and neck masses in pediatric patients. STUDY DESIGN Of the 128 cases studied, FNAC was performed in 74 patients and their cyto-histological correlation done. Sensitivity and specificity of cytological diagnosis was then computed. RESULTS Benign lesions were found to be more common than the malignant variety, the commonest being soft tissue tumors (46.87%). Lymphomas were the commonest tumors (22.6%) in the malignant category. Cytology was done in 74 patients of whom smears from 21 patients were unsatisfactory for diagnosis. There was one false positive and two false negative cases resulting in the specificity and sensitivity of FNAC in pediatric head and neck tumors to be 95.65% and 93.3% respectively. CONCLUSION FNAC is a useful and reliable tool in the diagnosis of head and neck masses with no contraindications and minimal complications even in children.

Solitary eosinophilic granuloma of the ulna: Diagnosis on fine needle aspiration cytology

Solitary eosinophilic granuloma is a part of the spectrum of Langerhans cell histiocytoses (LCH) which are rare diseases with varied clinical presentations. They comprise of three major overlapping syndromes: solitary eosinophilic granuloma (unifocal disease), Hand-Schueller-Christian disease (multifocal, unisystem), and Letterer-Siwe disease (multifocal, multisystem). A case of solitary eosinophilic granuloma of the ulna is presented here for its relatively uncommon incidence and the difficulty in making an accurate diagnosis based on the radiological picture alone. We hereby, emphasize the importance of a quick and reliable diagnosis based on fine needle aspiration cytology, and the need to consider the possibility of LCH in the differential diagnoses of a slide showing a large number of histiocytes and eosinophils, as in tuberculosis, Hodgkins disease, and other primary and metastatic bony lesions. Characteristic nuclear grooves and a large number of eosinophils help in clinching the cytological diagnosis.

Primary low-grade diffuse small lymphocytic lymphoma of the central nervous system

A 45-year-old Indian woman presented in neurosurgery outpatient with seizures, headache and vomiting for the past 1 month. MRI of the brain was suggestive of a malignant central nervous system (CNS) tumour. Histological and immunohistochemical examinations of stereotactic biopsy of the tumour were diagnostic of a low-grade diffuse small lymphocytic lymphoma of the CNS. No evidence of any occult systemic lymphoma was observed, confirming its ‘primary’ origin in the CNS. The diagnosis of a low-grade primary CNS lymphoma (PCNSL) is difficult as clinical and neuroradiological features are wide and variable. The clinical course is more indolent than a high-grade PCNSL and thus, a less aggressive and localised targeted treatment could be sufficient rather than the high dose, neurotoxic methotrexate-based chemotherapeutic treatment, recommended for high-grade PCNSL. Histological and immunohistological confirmation is therefore mandatory for early, appropriate treatment and prognostic implications.

Conjunctival cytology in glaucomatous patients using long-term topical therapy

Background: Long-term use of antiglaucoma drugs induces adverse changes on the conjunctival surface. Aim: To evaluate the cytological changes in the conjunctival scrape smears of patients receiving long-term antiglaucoma medication and their histopathological correlation. Materials and Methods: Conjunctival scrape smears were taken from the eyes of patients on long-term antiglaucoma therapy for over three months ( n = 75), patients taking antiglaucoma medication for less than three months ( n = 100) and from glaucomatous patients in whom trabeculectomy was done as a primary procedure. Inflammatory cell counts, fibroblasts, and the degree of metaplasia were then evaluated both cytologically and histologically. The t -test was used to determine the predictive values of these parameters for the surgical outcome of trabeculectomies. Results: Long-term use of antiglaucoma therapy leads to a higher stage of metaplasia with an increase in the number of fibroblasts, subepithelial collagen deposition, and inflammatory infiltrate within the substantia propria of the conjunctiva. Conclusions: Long-term antiglaucoma medications induce a significant degree of metaplasia in the conjunctival surface that adversely affects the outcome of filtration surgery.

Clinico-radiological and pathological evaluation of extra testicular scrotal lesions.

Background: Scrotal ultrasound, though reliable in distinguishing between intratesticular and extratesticular lesions and characterizing them as cystic and solid, cannot distinguish benign from malignant pathology. Although fine needle aspiration cytology (FNAC) has proved to be of great diagnostic importance in testicular lesions, its scope in extratesticular lesions is largely unexplored. Aim: To evaluate extratesticular scrotal lesions cytologically and compare it with their clinical, radiological, and histological findings. Materials and Methods: Sixty five patients with extratesticular scrotal lesions were assessed clinically, radiologically, and cytologically. Histopathology was done in 45 cases where surgical exploration was undertaken. All the data were then analyzed and correlated. Results: Extratesticular lesions accounted for 72.2% of the scrotal swellings. Of these, the epididymis is most commonly involved (61.5% cases) with the commonest type of lesion being cystic (49.3% cases). Ultrasonography preferably with color doppler is highly useful for the evaluation of the scrotum. Apart from distinguishing extratesticular from testicular and cystic from solid lesions, it has an important role in identifying individual lesions, thus reducing the list of differential diagnosis. Fine needle aspiration cytology contributed to a definitive diagnosis in 47.7% cases. It helps classify cystic masses on the basis of their contents and defines the etiology of chronic inflammatory lesions, apart from corroborating with the clinico-radiological diagnosis. Histological evaluation was possible only in cases where surgery was performed and helps further define the diagnosis. Conclusion: Fine needle aspiration cytology is essentially non-traumatic and easy to carry out and should be a technique of choice for the study of scrotal pathology, main advantage being avoidance of delays in diagnosis.

Neurofibroma of parotid.

Tumours of neurogenic origin are rare in parotid gland. The authors are presenting here a case of neurofibroma in a 40-year-male who presented with slow growing tumour in preauricular region of 1 year duration.

Aspergilloma lung mimicking tuberculosis

A 50-year-old male presented with haemoptysis. Patient had previous history of pulmonary tuberculosis. A tentative diagnosis of fungal ball was made on radiological examination. Surgical removal of lobe of lung was done and on histopathological examination a final diagnosis of aspergilloma was rendered.

Papillary microcarcinoma in clinically benign thyroidology

Context: Multi-nodular goitre (MNG) is one of the most common presentations of thyroid diseases. Although a benign entity, MNG has recently been associated with a significant risk of malignancy, as Papillary Thyroid Microcarcinoma (PTMC) is often an incidental finding in such patients. Aim: The objective of this study was to highlight the value of mandatory and diligent gross as well as histopathological examination in clinically benign thyroid specimens. Materials and Methods: This was a prospective study which included all the resected thyroid specimens of provisionally diagnosed MNG cases received in the histopathology laboratory of our department over a period of 6 months. Result: The microscopic examination showed a predominant picture of MNG along with foci of PTMC in 3 cases. Conclusion: All the patients with MNG who are treated conservatively need a close and careful follow-up for malignancy. In case of surgical treatment, careful grossing and histopathological examination of thyroid specimens is of utmost importance to identify minute foci of Papillary Thyroid Microcarcinoma (PTMC).