Shyama Jain

Esophageal tuberculosis: is it so rare? Report of 12 cases and review of the literature

OBJECTIVE:Mycobacterial involvement of the esophagus is rare in both immunocompetent and immunocompromised hosts with advanced pulmonary tuberculosis, even in countries with high prevalence rates like India. Most of the reported cases of esophageal tuberculosis (ET) are secondary to tuberculosis elsewhere in the body, most commonly pulmonary tuberculosis. Very few cases of isolated or primary ET have been reported, and most of them have been from developing countries. The upsurge in reported cases of tuberculosis linked to the AIDS epidemic has increased the incidence of this infection in developed countries also. Our aim is to study tuberculosis as an etiological factor in the causation of dysphagia, the role of cytology and histopathology in establishing its diagnosis, and the outcome of antitubercular treatment in these patients.METHODS:A hospital-based, retrospective study was performed. We reviewed records of all of the patients who underwent upper GI endoscopic examination for complaints of persistent dysphagia (>6 wk) in a tertiary care hospital in India between 1995 and 1999. Patients with abnormal endoscopic findings were subjected to endoscopic fine needle aspiration/brush cytology and biopsies. Those with pathological findings suggestive of tuberculosis were treated with antitubercular therapy.RESULTS:Tubercular involvement of the esophagus, confirmed by pathological examination, was found in 12 patients. They constituted 0.5% of all patients with persistent dysphagia, and 1.3% of all patients having abnormal esophagoscopic findings. Cytological examination provided a very useful diagnostic parameter in detection of these cases. Patients diagnosed as having ET responded well to antitubercular therapy.CONCLUSIONS:Tuberculosis as a causative factor for dysphagia should be considered in developing countries with high incidences of tuberculosis and in immunocompromised hosts. Detection of these cases by careful examination of cytological smears and biopsies and treatment with standard antitubercular therapy appear effective.

Aspiration cytology of Hashimoto's thyroiditis in an endemic area.

Aspiration cytology of Hashimotes thyroiditis in an endemic area

Oral versus high dose parenteral iron supplementation in pregnancy

To compare the effect of daily oral iron supplementation with two injections of high dose parenteral iron.

Fine needle aspiration biopsy in orbital lesions

PURPOSE . The study was performed to evaluate the efficacy of fine needle aspiration biopsy (FNAB) in orbital lesions. METHODS . Seventeen patients with orbital masses who had been fully investigated by non-invasive techniques participated in this study. FNAB was performed by standard technique, as an outpatient procedure, with ultrasound guidance in lesions posterior to the equator. A trained cytologist analysed all the smears. RESULTS . Specific results were obtained in 14 of the 17 (82%) patients studied by FNAB. Ten cases were neoplastic (8 malignant and 2 benign), 3 were inflammatory and 1 was a case of histiocytosis X. In 3/17 cases the results were non-specific. These were treated as pseudotumours and responded well to systemic steroids. In 7 cases the clinical and radiological diagnosis was confirmed by FNAB. Non-invasive investigations like USG, CT and MRI, however, failed to provide accurate diagnosis in the other 7 (41%) cases. In these patients, FNAB yielded a pathological diagnosis (histiocytosis X, cryptococcosis, non Hodgkins lymphoma, adenocarcinoma, pleomorphic adenoma, Schwannoma and cysticercosis), helping us to modify treatment with an excellent response. No significant complications were encountered following the aspiration biopsies. CONCLUSION . FNAB proved to be a reliable method for distinguishing between malignant and non-malignant lesions. It was found to be rapid, accurate, cost-effective, safe and a valuable addition to ultrasound, CT scan and MRI in the diagnosis of orbital lesions. This tool may help in avoiding a traumatic surgical intervention.

Disseminated histoplasmosis with reactive hemophagocytosis: aspiration cytology findings in two cases.

Two cases of disseminated histoplasmosis associated with reactive hemophagocytic syndrome are described. The clinical presentation was with prolonged unexplained fever and hepatosplenomegaly. On a strong clinical possibility of tuberculosis, antitubercular treatment was initiated in both patients. Lymph node (case 1), splenic (case 2), and bone marrow aspiration, however, showed sheets of proliferating histiocytes, and intracellular and extracellular histoplasma organisms. Aspiration cytology was thus valuable in establishing the final diagnosis. The patients had a fulminant clinical course and died of hemorrhagic shock within 48 hr of hospital admission before specific therapy could be initiated. Histoplasmosis can mimic tuberculosis clinically. There is a need for an increased awareness of the clinicopathological spectrum of histoplasmosis, especially its rarer manifestations as hemophagocytic syndrome. In suspected cases, aspirations from the lymph node, liver, and spleen can be performed safely and should be utilized for early diagnosis. Diagn. Cytopathol. 2000;23:422–424.

Cytomorphology of filariasis revisited. Expansion of the morphologic spectrum and coexistence with other lesions.

OBJECTIVE To review the cytomorphologic spectrum of the filarial worm and associated tissue response in 33 cases. STUDY DESIGN Retrospective analysis was carried out in clinically unsuspected cases of filariasis diagnosed on cytology over a period of 10 years. Twenty-nine aspirate smears from 28 patients were air dried and stained with May-Grünwald-Giemsa stain. Four routine cervical smears and one centrifuged smear of urine were stained with Papanicolaou stain. RESULTS Microfilariae alone and along with adult gravid females were present in 25 and 4 cases, respectively. In one case both adult male and female worms with microfilariae and eggs were seen. The diagnosis was based on the presence of eggs alone in one case and fragments of female worms in two. Four of these cases were neoplastic lesions, and microfilariae were found incidentally. In one case of splenomegaly microfilariae were seen along with Leishman-Donovan bodies. CONCLUSION Filariasis can be diagnosed on cytology by demonstrating microfilariae, a male or female worm, or eggs alone. It can be seen in association with neoplastic lesions and rarely with other parasitic infections.

Morphologic spectrum of papillary carcinoma of the thyroid: role of cytology in identifying the variants.

OBJECTIVE To evaluate the efficacy of fine needle aspiration cytology (FNAC) in the diagnosis of morphologic variants of papillary carcinoma of the thyroid (PCT) and to determine the reasons for misdiagnosis in discrepant cases on cytology. STUDY DESIGN Fine needle aspiration smears from 158 histologically proven cases of PCT were blindly reviewed and an attempt made to subclassify them into different variants on the basis of various architectural and morphologic features. Cytohistologic correlation was performed to assess the efficacy of cytology in correctly identifying these variants. RESULTS In cases with satisfactory aspirates, the diagnosis of papillary carcinoma was correctly made in 112 of 139 (80.5%) histologically proven cases of PCT. Subclassification was correct in 87 of 96 (90.6%) cases of classic papillary carcinoma and in 25 of 43 (58.1%) of the other variants of PCT with adequate aspirates. Cytohistologic agreement was 100% in columnar cell variant (CCV) and high grade variant (HGV). Although there was overlap in the morphologic features of tall cell variant (TCV) and Hürthle cell variant, cytology correctly identified 60% and 76.4% of these cases, respectively. The accuracy of cytology was limited in diagnosing follicular variant as only 50% of these cases could be correctly typed on cytology. Nodular fascitis-like stroma and diffuse sclerosis variants could not be diagnosed on cytology. CONCLUSION Though FNAC is of limited value in typing the variants of PCT due to overlapping morphologic features, it can provide clues to the diagnosis in certain aggressive variants such as TCV, CCV and HGV. Early diagnosis in these cases can assist clinicians with management.

Marginal Vacuoles in Thyroid Aspirates

OBJECTIVES To report on two cases of metastatic follicular carcinoma with marginal vacuoles (MVs) and review smear results in 441 solitary nodular goiters (SNGs) for this cytologic feature. STUDY DESIGN The first case was a 55-year-old male who presented with a huge mass in the left hip region; the second case was a 50-year-old male with a thyroid nodule and a large mass on the scalp. The age of the 441 ultrasonographically diagnosed SNG cases ranged from 11 to 75 years. The May-Grünwald-Giemsa-stained fine needle aspiration (FNA) smears of these cases were reviewed by one of the authors (D.K.D.) for various cytomorphologic features, including MVs. RESULTS FNA smears from the mass in the hip in the first case showed follicular cells with acinar formation and MVs, indicating metastatic follicular thyroid carcinoma (FTC). These features were of help in detecting the thyroid primary, which had previously gone undetected. Aspiration smears from the thyroid nodule and the mass on the scalp in the second case showed tumor cells of FTC with MVs and microfilariae. Review of 441 SNG cases revealed MVs in 42.6% of hyperplastic nodules; that rate was significantly higher (P < .001) than that of colloid goiter (5.2%) and neoplastic goiter (13.3%) but lower (P < .05) than that of thyrotoxic goiter (100%). MVs were limited to neoplasms with a follicular component; that included 15% of follicular neoplasms and 50% of follicular variant of papillary carcinoma (FVPC). The difference between FVPC and the rest of the neoplastic goiters (6%) was statistically significant (P = .002).

Microfilariae in association with neoplastic lesions: report of five cases.

Microfilariae in association with neoplastic lesions: Report of five cases

Cytomorphologic Spectrum in Paraganglioma

OBJECTIVE To study the detailed cytologic features of paragangliomas (PGs) and delineate features helpful in predicting behavior. STUDY DESIGN We performed retrospective analysis of 12 cases cytologically suggested as PG over a period of 10 years. Smears were reviewed for cellularity, pattern, shape, cytoplasm, nuclear features and background. Cytologic diagnosis was correlated with clinicoradiologic features, histologic features and immunocytochemistry. RESULTS Patient age ranged from 12 to 65 years, with male preponderance; they presented with a mass lesion. Sites involved were head and neck (5), retroperitoneum (5) and mediastinum (2). Smears were cellular; cells were round to oval, plasmacytoid and spindled and seen as scattered, in clusters, acinar and perivascular pattern. The most consistent feature was presence of pink granules. Pleomorphism was present in all but 1 case and less prominent in tumors with metastasis. Mitoses were more frequently seen in malignant cases. CONCLUSION Cytologic features of PG are diverse. Although there are certain main features, they are not diagnostic unless combined with data on site, histology and ancillary studies. Presence of granules, mild pleomorphism, frequent mitoses and necrosis needs careful evaluation for malignancy potential and warrants close follow-up.