Srinivasan Radhika

Cytology of Primary Skin Tumors

OBJECTIVE To evaluate the role of fine needle aspiration biopsy (FNAB) in the diagnosis of primary skin and adnexal tumors and to study the cytomorphology of various primary skin and adnexal tumors. STUDY DESIGN FNAB was routinely done in 18 cases of skin and adnexal tumors, and the cytologic diagnosis, along with detailed cytomorphology, was correlated with subsequent histology. RESULTS FNAB was done on 15 cases of primary skin tumors and 3 cases of recurrent lesions. FNAB successfully established the benign or malignant nature of skin tumors in 16 of 18 cases (88.9%). However, subtyping was possible in only 12 of 18 cases (66.7%). CONCLUSION Clinical history and physical findings are essential to the proper diagnosis of adnexal tumors. Knowing the cytologic features of primary skin neoplasms helps distinguish them from tumors metastatic to the skin and more commonly referred for FNAB.

Outcome of adult acute lymphoblastic leukemia with BFM protocol in a resource-constrained setting

Cure rates for adult acute lymphoblastic leukemia (ALL) in developing countries are significantly lower because of problems unique to these countries. We assessed some of the problems in adult ALL patients (>12 years of age) in a tertiary care hospital of northwest India with modified BFM regimen. The diagnosis of ALL was made according to FAB criteria. The protocol consisted of Phase I & II induction, consolidation, reinduction and maintenance phases. CNS prophylaxis was administered with 24 Gy radiation and intrathecal methotrexate. One hundred and eighteen patients (72.9% males), aged 12 – 68 years (median 23 years) were treated from January 1997 till December 2003. Follow-up of patients was done till December 2005. Complete remission (CR) was achieved in 85.6% patients after induction therapy and 40% patient relapsed. Most patients (23.7%) relapsed during the maintenance phase or after completion of chemotherapy. At least 15% of patients (15/101) after successful induction abandoned the treatment because of financial constraints, prolonged travel time to treatment facility and switching over to alternative medicines. Fatal infectious complications occurred in 19.5% of patients. The 3-year and 5-year event free survival rates were 29.8% and 21.6% respectively. In conclusion, modified BFM regimen resulted in high induction rates but relatively poor 5-year event free survival. Infections related death and post induction abandonment of treatment were the main reasons for poor overall results.

Adverse impact of pretransplant polyoma virus infection on renal allograft function

Background:  BK polyoma virus (BKV) has emerged as an important cause of acute and chronic allograft injury in renal transplant recipients. Reactivation of latent infection requires reduction in cell‐mediated immunity. We hypothesized that BKV could get reactivated in the urinary tract of patients with end‐stage renal disease (ESRD) and impact the allograft function after these individuals undergo transplantation.

Fine needle aspiration cytology of cystic partially differentiated nephroblastoma. A case report.

BACKGROUND Cystic partially differentiated nephroblastoma (CPDN) is an uncommon childhood kidney tumor. CASE For the first time, in this case report we describe the cytologic features of this entity. Predominant clusters and rows of cells with occasional discrete blastemal cells on cytologic smear along with multiple hypoechoic cystic spaces on radiology suggested CPDN. CONCLUSION It is essential to diagnose CPDN preoperatively because the tumor needs only nephrectomy for treatment.

Mean gestation at delivery and histological chorioamnionitis correlates with early-onset neonatal sepsis following expectant management in pPROM

Abstract This prospective observational study was carried out in India among 100 women with preterm pre-labour rupture of membranes (pPROM) between 260/7–330/7 weeks on expectant management in order to correlate early-onset neonatal sepsis (EONS) with various features of chorioamnionitis. The incidence of pPROM during the study period of 1.5 years was 7%. The mean gestation at pPROM was 306/7 ± 1.8 weeks and at delivery was 321/7 ± 1 weeks. Features of chorioamnionitis in the form of clinical, microbiological, histological or a combination of these were observed in 70/100 women. Clinical chorioamnionitis was seen in 16%, bacterial isolates were present in 30% on cervical swab and in 39% on placental membrane culture and 19% had histological chorioamnionitis. EONS was present in 23/97 (24%). Clinical chorioamnionitis (p = 0.069), bacterial isolates on cervical swab (p = 0.56) or placental membranes (p = 0.39) were not found to predict EONS; whereas histological chorioamnionitis (p = 0.002) and lower gestation at delivery (p = 0.013) were significantly associated with EONS.

Role of Fine needle aspiration cytology of spleen

To evaluate the role of fine needle aspiration cytology (FNAC) of spleen in a tertiary care referral centre. FNAC of spleen was done in a total of 130 cases under ultrasonological guidance over a period of 5 years in a tertiary care centre. There were 76 male and 54 female including nine paediatric patients and the age range of the patients was from 2 to 70 years. All patients were evaluated for HIV, Hepatitis B antigen and coagulation profile before the procedure. Of 130 FNAC cases, 26 were inadequate, while 16 were normal splenic aspirate. A definite diagnostic opinion was possible in 88 cases. In this study, there were 13 cases of tuberculosis, 25 cases of granulomatous inflammation, 10 cases of acute suppurative inflammation, and one case each of leishmaniasis, aspergillosis and extramedullary hematopoiesis. In the neoplastic group, we had 26 cases of non‐Hodgkins lymphoma, one case of Hodgkin lymphoma and 10 cases of metastatic malignancies. No complications were encountered during FNAC in any of the cases. With proper patient evaluation and emergency backup, USG guided fine needle aspiration cytology of spleen is a safe, easy and rapid procedure for definite diagnosis of neoplastic and non‐neoplastic splenic pathology.

Fine-needle aspiration cytology of orbital meningiomas

Meningiomas are benign tumors derived from arachnoid cells. Most commonly they arise within the cranial cavity, but they may arise extracranially in various anatomic sites. We present four cases of orbital meningiomas diagnosed on fine‐needle aspiration cytology (FNAC) and confirmed on histopathology. All the cases are presented with orbital mass. FNAC smears showed classical whorling and syncytial pattern of cells, withround to oval nucleus, inconspicuous nucleoli and one eachcase showed intranuclear inclusion and psammoma bodies. FNAC diagnosis of such lesions is difficult, because cytological features may mimic other soft tissue lesions located in orbital region. Awareness of this entity and its cytological appearance is important to allow correct diagnosis. Diagn. Cytopathol. 2012.

Fine-needle aspiration biopsy of angio-immunoblastic lymphadenopathy

In this article, we have described the fine‐needle aspiration biopsy (FNAB) of five cases of angioimmunoblastic lymphadenopathy (AILD). FNAB of these cases showed large number of capillary fragments, along with polymorphous population of cells consisting of plenty of immunoblasts, plasma cells, eosinophils, and mast cells. Two cases showed clusters of clear cells. It is essential to have detailed clinical features for FNAB diagnosis of AILD. Histopathology is advisable in all the fresh cases. FNAB is helpful for screening and follow‐up of AILD. Diagn Cytopathol 1996;15:412–414.

Spectrum of fungal and parasitic infections on fine needle aspiration cytology

The incidence many fungal and parasitic lesions are on the rise over the decades. In this study, we have analyzed the spectrum of fungal and parasitic lesions diagnosed on fine needle aspiration cytology (FNAC) in a tertiary health care center.

Endodermal sinus tumor: a rare cause of calcified peritoneal implants

Abstract Calcified peritoneal implants have been attributed to various malignant and benign causes. We present an interesting case of a 32-year-old woman who presented with abdominal pain, distension and vaginal bleeding. Contrast-enhanced computed tomography revealed calcified peritoneal implants with a malignant ovarian mass. Histopathology showed an endodermal sinus tumor, a rare cause of calcified peritoneal carcinomatosis.