Savita Agarwal

Diagnostic utility of ki67 and p53 immunostaining on solitary thyroid nodule - A cytohistological and radionuclide scintigraphic study

BACKGROUND For management of thyroid nodules, distinction between benign and malignant tumors is essential. Present study was undertaken to differentiate between benign and malignant lesions by using Ki-67 and p53 immunostaining and radionuclide perfusion scan. MATERIALS AND METHODS Study comprised of 25 prospective and 25 retrospective cases of solitary thyroid nodules. Fine needle aspiration was done on 25 prospective cases, which was correlated with histopathological diagnosis in 24 surgically excised cases. Immunostaining for p53 and Ki-67 was put on histopathological sections of 25 retrospective and 24 prospective cases. Radionuclide perfusion scan was performed and vascularity patterns were compared with their pathological nature to differentiate between benign and malignant nodule. RESULTS Cytohistological correlation was present in 80% of cases. On immunostaining, significant difference in mean value of Ki67 positivity was found between benign and malignant nodules (P < 0.05). On p53 immunostaining significant difference was observed in counts of benign and malignant lesions (P = 0.037). On radionuclide perfusion scan mean of difference between maximum and minimum perfusion activity between benign and malignant nodules was found to be statistically significant (P = 0.04), however there was no correlation between perfusion patterns and antigenic characteristics. CONCLUSIONS P53 and Ki-67 immunostaining along with radionuclide perfusion scan appears to be useful tools to differentiate between benign and malignant lesions in solitary thyroid nodule; however, more studies are needed to confirm this observation.

Primary thyroid lymphoma: A rare disease.

Primary thyroid lymphomas are rare neoplasms comprising of 1-5% of thyroid malignancies. These are predominantly B-cell in origin. Here, we report a case of 60 years lady, a known case of lymphocytic thyroiditis, diagnosed as thyroid lymphoma (diffuse large B-cell) on fine needle aspiration and confirmed histopathogically and immunohistochemically. She presented with a sudden increase in thyroid swelling. Fine needle aspiration performed showed highly cellular smears comprising predominantly of the monomorphic population of medium to large sized lymphoid cells with high nuclear/cytoplasmic ratio and scant cytoplasm. A possibility of thyroid lymphoma possibly diffuse large B-cell lymphoma was suggested which was later confirmed on biopsy. Fine needle aspiration provides an easy mode for diagnosing large cell lymphoma like diffuse large B-cell. Hence, an early diagnosis is possible for a timely intervention. Also, cases of lymphocytic thyroiditis should be regularly followed for the development of lymphoma.

Efficacy of bronchial brush cytology and bronchial washings in diagnosis of non neoplastic and neoplastic bronchopulmonary lesions.

OBJECTIVE The present study is based on the cytologic evaluation of bronchial brushings for the diagnosis of non neoplastic and neoplastic bronchopulmonary lesions and relation of the cytologic findings with clinical diagnosis and histopathologic examination wherever possible. MATERIAL AND METHOD 35 symptomatic patients were selected on whom bronchoscopy was done. Bronchial brushing was performed using straight brushes and bronchial washing specimens were collected after brushing samples. Smears were stained by Pap, H&E, and Giemsa in all the cases while PAS and Ziehl Neelsen stainings were done in selected cases. Endobronchial biopsy was performed using a flexible long biopsy forceps. RESULTS The age of the patients varied from 18 to 88 years, and the male:female ratio was 3.3:1. Carcinoma was diagnosed in 21 (60%) out of total 35 cases on bronchial biopsy and the remaining 14 cases (40%) showed inflammatory, tuberculous or no significant pathology. Bronchial washing showed 10 true positive, 10 true negative, 4 false positive and 11 false negative cases whereas bronchial brushing showed 17 true positive, 12 true negative, 2 false positive and 4 false negative cases as confirmed on biopsy. Bronchial brushing showed good sensitivity (80.9%) and specificity (85.7%) compared to bronchial washing which had sensitivity of 47.6% and specificity of 71.4%. CONCLUSION These findings attempted to confirm the concept that pulmonary cytology has improved to the point that its sensitivity is high enough to justify its use as a definitive diagnostic tool in those cases in which tissue diagnosis is not possible.

Spindle cell lipoma masquerading as lipomatous pleomorphic adenoma: A diagnostic dilemma on fine needle aspiration cytology.

Spindle cell lipoma is a relatively uncommon benign adipocytic tumor that usually presents in subcutaneous fat of adult men. These are a rare form of lipoma, accounting for 1.5% of all lipomatous tumors, with a low rate of local recurrence and no risk of malignant behavior/dedifferentiation. Although few studies addressing the histological findings of spindle cell lipoma have been described, only a few descriptions of fine needle aspiration cytology (FNAC) findings have been documented in literature. We present a case of a 55-year-old male with a nodular swelling over left cheek (in the parotid region), which due to its location as well as prominent myxoid background prompted us to include the lipomatous salivary gland lesions in differential diagnosis. Our objective is to document and delineate the characteristic cytological features of spindle cell lipoma, which may permit a confident diagnosis on FNAC smears.

Rare Pediatric Adrenocortical Carcinoma with Oncocytic Change: A Cytologic Dilemma

Pediatric adrenocortical carcinoma is extremely rare with a prevalence of 0.3 per million. Adrenocortical neoplasms in children usually present with one of the endocrine abnormalities. Adrenocortical neoplasms cannot be easily diagnosed on cytopathology; hence, the cytomorphological features posing diagnostic dilemmas are discussed in a pediatric patient presenting with palpable abdominal mass and virilization. Fine-needle aspiration smears were cellular showing cells in cohesive clusters adhering to central core of capillaries exhibiting an endocrine vascular pattern along with single cells and stripped nuclei. Cells were polygonal in shape and had abundant cytoplasm with well-defined borders and round eccentric nuclei with prominent nucleoli. Marked anisonucleosis was also noted. Few cells showed abundant granular cytoplasm resembling oncocytes. Many bizarre and multinucleated cells, few mitotic figures, and necrosis were also seen. Hematoxylin and eosin-stained sections of tumor biopsy suggested possibility of adrenocortical neoplasm. A panel of immunohistochemical markers were used to exclude possibility of renal cell carcinoma (RCC) and pheochromocytoma that showed vimentin (+), cytokeratin (−), inhibin-α (+), neuron-specific enolase (focally +), and chromogranin (−). The Ki67 index was 15%, and P53 was strongly positive. It is difficult to distinguish adrenocortical neoplasm, RCC, and pheochromocytoma on cytology because of overlapping features; hence, important cytological features which help in distinguishing between the three are discussed.

Mesenchymal hamartoma mimicking hepatoblastoma: A cytological pitfall.

The case of a 9-month-old infant who presented with an abdominal mass since birth is discussed here. Fine-needle aspiration (FNA) cytology of this mass was performed, from which it was thought to be a small round tumor, possibly a hepatoblastoma (HB). Histopathologically, however, it was found to be a mesenchymal hamartoma (MH). This case report thus highlights this cytological limitation.

Unusual multicentric angiomyolipoma of knee joint and soft tissue foot

To report unusual occurrence of angiomyolipoma at intraarticular location with another lesion in the same side foot. A 12-year-old girl was referred to us after initial inconclusive work-up done elsewhere for swelling of left knee joint. There was a 15 × 12 cm swelling in the knee joint partially encasing patella while also a similar hourglass shaped swelling measuring 9 × 4 cm was noted in the same side foot. After clinical and radiological evaluation an excision biopsy was planned for both sites. The specimen sent for histopathological evaluation revealed angiomyolipoma with identical characteristics in the two locations and was HMB45 immunostain negative. Patient was evaluated for possibility of tuberous sclerosis but there was no contributory evidence. Angiomyolipoma is typically a solitary renal tumor with rare occurrence at musculoskeletal sites. Multicentric variety is still infrequent. Intraarticular occurrence of angiomyolipoma presents a diagnostic challenge not only in terms of unfamiliarity but also unusual presentation with absence of characteristic immunostaining and multicentricity requiring careful exclusion of other lesions that may require a more radical approach for treatment.

Evaluation of the efficacy of post prostatic massage urine cytology in diagnosis of various prostatic lesions with cytohistological and clinical correlation

Background: Elderly men are at high risk of various prostatic diseases carrying high morbidity and mortality rates. For screening large populations, there is a need for a simple, reliable, and noninvasive test with high sensitivity and specificity. Exfoliated prostatic cancer cells can be harvested by prostatic massage and subjected to cytologic examination and molecular tests. Aims: This study was undertaken to evaluate the morphology of various prostatic lesions on post prostatic massage urine cytology and correlate cytologic, histologic, and clinical findings. It was further proposed to establish the diagnostic accuracy of post prostatic massage urine cytology in different prostatic lesions. Materials and Methods: Totally, 100 cases including 50 cases each from study group and control group were subjected to post prostatic massage urine cytology and correlated with clinical and histological findings. Results: Five out of 50 cases were diagnosed as prostatic carcinoma, of which 60% were clinically detected. Diagnostic accuracy by histology and cytology independently was 80%, and 20% remained false negative by each technique. On combining both the techniques, diagnostic accuracy was 100%. For nine cases each of prostatitis and nodular hyperplasia diagnosed clinically, the diagnostic accuracy by cytology was 100 and 66.6%, respectively. 62% (31) cases were diagnosed as nodular hyperplasia including 22 (44%) cases of nodular hyperplasia with prostatitis. Conclusion: Collection of urinary specimens after prostatic massage provides adequate samples for cytological examination and carries great importance in establishing the preoperative morphologic diagnosis in cases of malignancy, prostatitis, and prostatic calculi.

Cytodiagnosis of idiopathic calcinosis cutis: a case report.

Abstract We report a case of idiopathic calcinosis cutis diagnosed by fine needle aspiration cytology in a 50-yr-old female who presented with a subcu taneous swelling near the left iliac crest. Cytological finding of amorphous calcium salts with histiocytes and the appropriate clinical background led to the cytodiagnosis of idiopathic calcinosis cutis as subsequently confirmed on histopathology. Pitfalls in the diagnosis of calcinosis cutis on cytology smears are also discussed Öz Sol iliak krest yakınında soliter subkutan nodülü olan ve ince iğne aspirasyon biopsisi ile tanı konan 50 yaşında kadın idiopatik kalsinozis kutis olgusu sunulmuştur. Klinik veriler ışığında değerlendirilen yaymalarda sitolojik olarak amorf kalsiyum tuzları ve histiyositlerin varlığı, uygun klinik verilerle birlikte idiopatik kalsinozis kutis sitopatolojik tanısına ulaşmayı sağlamış ve bu tanı histopatolojik olarak doğrulanmıştır. Kalsinozis kutis tanısının sitolojik yaymalarda karşılaşılan zorlukları tartışılmıştır.

Congenital peripheral ameloblastic fibroma with intraosseous involvement in a 2-week-old infant: A case report with review of literature.

Ameloblastic fibroma is a rare, slow-growing benign mixed odontogenic tumor. It constitutes 2% of odontogenic tumors and is reported to occur at an age ranging from 6 months to 42 years. The youngest being a 7-week-old infant. We report a case of peripheral ameloblastic fibroma in a 2-week-old infant. The lesion presented since birth. It involved the maxilla with an extraosseous component involving the gingiva. A more or less conservative surgical approach of enucleation and curettage of the lesion was done under general anesthesia, trying to conserve the adjacent tooth buds. Only a few cases of congenital peripheral ameloblastic fibroma have been reported so far.