Seema Aggarwal

Koilocytosis: correlations with high-risk HPV and its comparison on tissue sections and cytology, urothelial carcinoma.

The aim of this study were (1) To correlate koilocytosis with high risk HPV(HrHPV) DNA in urinary bladder carcinoma and (2) To compare detection of koilocytosis on tissue sections and urine cytology. Biopsy and cytologic specimens from 33 patients of urinary bladder carcinoma were analyzed. HPV DNA was detected by PCR on biopsy specimens using consensus primers MY09 and MY11. Koilocytosis was assessed both on tissue sections and urine cytology. HrHPV DNA was found in 14 of 33 bladder carcinoma. Koilocytosis was seen in tissue sections from 13 patients. Eleven of these were HrHPV DNA positive (positive predictive value 84.6%). Koilocytosis was seen in urine cytology in three patients. All three were positive for HrHPV DNA. To conclude koilocytosis is a good morphological marker for HrHPV DNA in the urothelium. Tissue sections are better than cytologic smears for detection of koilocytes. Diagn. Cytopathol. 2009.

Cytokeratin-20 immunocytochemistry in voided urine cytology and its comparison with nuclear matrix protein-22 and urine cytology in the detection of urothelial carcinoma.

This study was done on 59 subjects (42 urinary bladder carcinoma patients and 17 non‐neoplastic controls). Urine cytology and bladder chek NMP22 test was done on all cases. CK20 immunostaining was performed on archived papanicolaou stained urine cytology smears in 34 cases (27 bladder carcinoma and 7 negative controls). Results of all three tests (cytology, NMP22, and CK20 immunostaining) were compared with histopathology to evaluate the accuracy of individual test. The combination of cytology and NMP22 was compared with combination of cytology and CK20 immunostaining for detection of bladder carcinoma. NMP22 had sensitivity of 92.9% and specificity of 70.6%, as compared with voided urine cytology (sensitivity of 76.2% and specificity of 76.5%) and CK20 immunostaining (sensitivity of 70.4% and specificity of 71.4%). Combination of cytology and NMP22 gave better results (sensitivity of 88.1% and specificity of 88.2%) than combination of cytology and CK20 immunostaining or any other test in isolation. Diagn. Cytopathol. 2012.

Usefulness of NMP22 as an adjunct to a typical urine cytology and low-grade urothelial carcinoma.

The usefulness of urine cytology combined with NMP22 was evaluated for the primary diagnosis of urothelial carcinoma. Of 53 clinically suspected patients, histopathological diagnoses were low‐grade urothelial carcinoma (25), high‐grade urothelial carcinoma (13), and inflammatory lesions (15). Cytology was positive in 25 and negative in 14 patients. Fourteen of 25 low‐grade urothelial carcinoma and 11/13 high‐grade urothelial carcinoma were diagnosed correctly on urine cytology. Atypical cells seen in 14 patients were categorized as inconclusive for malignancy. The overall sensitivity of urine cytology was 65.8%, whereas specificity was 100%. NMP22 was positive in 33 patients. Of these 30, 18 low‐grade and 12 high‐grade lesions were true positive. Of the 20 NMP22, eight negative cases were false‐negative. Ten of 15 with negative histopathology were also negative for NMP22, three were false‐positive, and two showed erratic results. Nine of 14 cases with atypical urine cytology were positive for NMP22. Eight of these showed low‐grade carcinoma on histopathology. The sensitivity of BladderChek NMP22 test was 79%, whereas specificity was 80%. NMP22 BladderChek test is a useful adjunct to urine cytology in atypical and low‐grade carcinoma. Diagn. Cytopathol. 2010;38:788–790.

Cartilaginous metaplasia in uterine leiomyoma

IntroductionLeiomyoma is the most common tumor in the uterus. A spectrum of histologic variants have been noted, however, metaplasia in the leiomyoma is a rare phenomenon. Adipose metaplasia being most commonly reported. Cartilaginous metaplasia in leiomyoma is very rare.Materials and methodsWe report first case of pure cartilaginous metaplasia in a uterine leiomyoma.ConclusionCartilaginous areas although rare, may appear in uterine leiomyoma.

Diagnostic usefulness of fragments of crushed cells in autoimmune thyroiditis

Fine‐needle aspiration cytology has emerged as an important diagnostic tool in cases of autoimmune thyroiditis. However, the patchy nature of this disease and its coexistence with other thyroid pathologies, with only subtle demonstrable cytologic features in many cases can lead to misdiagnosis. Of 313 thyroid aspirates, 62 were diagnosed as autoimmune thyroiditis. Fragments of crushed cells were observed in 51 (82.11%) of autoimmune thyroiditis (P < 0.001). The presence of “crush artifact” that can be easily picked up on low magnification should be used as an important criterion for the diagnosis of thyroiditis. It is particularly helpful in cellular smears from thyroiditis to avoid misdiagnosis of neoplasia. Diagn. Cytopathol. 2012;40:E38–E42.

Bursal gouty tophus: Fine-needle aspiration cytology intrabursal tophus on FNAC

Dear Dr. Bedrossian: Gouty tophi have often intrigued clinicians and pathologists by mimicking various benign and malignant lesions. The diagnostic dilemma can be successfully resolved by fine-needle aspiration (FNA) cytology. The presence of needle shaped, negatively birefringent crystals of monosodium urate (MSU) present in stacks or scattered singly, is a characteristic finding in gouty tophus. We describe a case where unsuspected diagnosis of gouty tophus was made on fine-needle aspiration cytology, in a swelling overlying the elbow joint. Cytology smears showed classical monosodium urate crystals surrounded by synovial cells, suggesting that the tophaceous deposits were located within the olecranon bursa. A 35-year-old male was clinically suspected of having rheumatoid arthritis, and was referred for FNA of a nodular soft tissue swelling on the posterior aspect of elbow joint. He had no radiological evidence of any bony abnormality. The uric acid level was 6.0 mg/dl. The FNA yielded chalky white material with scant fluid which on May-Grunwald Giemsa and Papanicolaou stained smears showed amorphous material and classical fine-needle shaped crystals arranged in sheaves and scattered singly (Fig. 1). The interesting finding, however, was that sheaves of needle-shaped crystals were surrounded by proliferating synovial cells (Fig. 2), along with presence of synovial cells, polymorphonuclear leucocytes, giant cells and histiocytes, in the background. These cytological findings were similar to the histology of synovial biopsy in intra-articular tophi, which shows proliferation of synovial cells and infiltration of histiocytes around tophaceous deposits. These observations suggest that the tophaceous deposits were in relation to and possibly located in the olecranon bursa. Thus fine-needle aspiration cytology not only aided in diagnosing gouty tophus but also pointed out its possible intra-bursal location. Gout is a disease resulting from the effects of hyperurecemia, and a crystal induced arthropathy. Tophaceous deposits occur due to deposition of MSU or uric acid crystals in joints and periarticular tissue of appendicular skeleton. In and around the joints, tophi occur in the synovium, articular cartilage, subchondral bone, joint capsule, ligaments, tendons, bursa, and subcutaneous tissues. Central to the deposition of MSU crystals in the synovium is the fact that synovial fluid is a poorer solvent for MSU than plasma and so with hyperurecemia the urate crystals in the joint fluid become supersaturated, particularly in peripheral joints, which may have temperatures as low as 208C. With prolonged hyperurecemia, crystals and microtophi of urate develop in the synovium. FNA is now considered a standard technique for diagnosing gouty tophus and is an alternative to synovial biopsy. American college of rheumatology, in its published criteria for diagnosing gout, has stated that the presence of uric acid crystals in joint fluid or a tophus containing urate crystals is highly suggestive of gout.

Cytomorphological diagnosis of tendinous xanthomatosis: a case report.

Xanthoma is a reactive histiocytic proliferation in response to altered lipid levels. These develop usually in skin and subcutis but may also develop in deep soft tissue as tendon sheath or synovium. We report a rare case of tendinous xanthomatosis in a 23‐year‐old female, diagnosed on aspiration cytology. Diagn. Cytopathol. 2010.

Pleural mesothelioma: an unusual case diagnosed on pleural fluid cytology and immunocytochemistry.

Mesothelioma is a rare neoplasm with relationship to occupational and environmental exposure to asbestos. Its accurate and early diagnosis is often difficult. We present an unusual clinical presentation and diagnostic dilemma in a 30‐year‐male, who presented with neck pain and diffuse edema of left upper limb. The color Doppler ultrasound revealed venous thrombosis. The right supraclavicular lymph node biopsy revealed a poorly differentiated carcinoma. The patient had mild bilateral pleural effusion, the characteristic cytomorphological features of mesothelioma on fluid cytology were helpful in establishing the diagnosis. Diagn. Cytopathol. 2009.