Subhash K. Gupta

Image-guided percutaneous drainage of thoracic empyema: Can sonography predict the outcome?

Abstract. The aim of this study was to assess the safety and efficacy of image-guided percutaneous catheter drainage (IGPCD) of thoracic empyemas, and to correlate the outcome of IGPCD with the pre-procedural sonographic appearance. One hundred three patients (74 males and 29 females) with thoracic empyema (age range 1 month to 70 years, median age 28 years) underwent IGPCD. In 63 (61.17 %) patients, IGPCD was the primary treatment modality; in 40 (38.84 %) patients it was used after unsuccessful intercostal chest tube drainage (ICTD). Ultrasound was the main modality used for guidance; CT guidance was used in only 7 patients (6.8 %). Eight- to 12-F pigtail catheters or 10- to 14-F Malecot catheters were used. The outcome was correlated with the pre-procedural US appearance (anechoic, complex non-septated or complex septated) of the empyema. The IGPCD technique was successful in 80 of 102 patients. Based on the US appearance, IGPCD was successful in 12 of 13 (92.3 %) patients with anechoic empyemas; 53 of 65 (81.54 %) patients with complex non-septated empyemas, and in 15 of 24 (62.5 %) patients with complex septated empyemas. A statistically significant difference (p < 0.01) was seen in the outcome of IGPCD in the three categories. Twenty-two patients required further treatment: ICTD (n = 9; 2 of them later also underwent surgery); and surgery (n = 15). The duration of catheter drainage ranged from 2–60 days. No major complications were encountered. Percutaneous catheter drainage of thoracic empyemas with imaging guidance ensures accurate catheter placement with a high success and a low complication rate. Pre-procedural US can predict the likelihood of success of IGPCD.

Ilio-psoas abscesses: Percutaneous drainage under image guidance

Over a 5-year period, 56 psoas abscesses occurring in 51 patients were managed by image-guided percutaneous drainage, either by needle aspiration (n = 10) or by catheter drainage (n = 46) in conjunction with medical therapy. Twenty-seven patients had tuberculous abscesses (bilateral in five) while 24 patients had pyogenic abscesses. Percutaneous treatment was successful in 16 of the 24 patients (66.7%) with pyogenic abscesses. The reasons for failure were co-existent bowel lesions, phlegmonous involvement of muscle without liquefaction, multiloculated abscess cavity and thick tenacious pus not amenable to percutaneous drainage. Surgery was required in seven patients, either for failed percutaneous drainage or for the management of co-existent disease. Percutaneous drainage was initially successful in all 27 patients of tuberculous psoas abscesses. However, eight patients presented with recurrence requiring repeat intervention. The average duration of catheter drainage was longer in patients with tuberculous abscess (11 days) than in patients with pyogenic abscess (6 days). Percutaneous drainage under image guidance provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses.

Fine Needle Aspiration Cytology in the Diagnosis of Tuberculous Mastitis

OBJECTIVE To study the relationship between granulomas in the breast and tuberculous mastitis. STUDY DESIGN Retrospective analysis of 22 breast aspirates that showed epithelioid cell granulomas. The aspirates were reviewed and the cytomorphologic findings summarized. RESULTS Aspiration cytology revealed epithelioid cell granulomas along with giant cells, necrosis and inflammatory cell infiltrate. Overall acid-fast bacillus (AFB) positivity was 22.7%. AFB positivity was greater in the presence of necrosis when epithelioid cells were absent. CONCLUSION In a country like India, the diagnosis of granulomatous mastitis must be made with caution, even in the absence of AFB. Only after a sufficient trial of antituberculosis treatment has been given and the patient fails to respond should an alternative diagnosis be suggested.

Sonographically guided fine-needle aspiration biopsy of lytic lesions of the spine: Technique and indications

We report the use of sonography to guide fine‐needle aspiration biopsies (FNABs) of lytic lesions of the spine.

Spermatocytic seminoma: a cytology and histology case report with review of the literature.

Fine‐needle aspiration cytology (FNAC) findings are described in a case of spermatocytic seminoma occurring in a 52‐yr‐old male, involving the left testis. The smears showed three populations of cells (small, medium, and large), with a preponderance of medium‐sized cells showing visible nucleoli. The background was clean, in contrast to the “tigroid” substance seen in classical seminoma. Low mitotic rate and absence of lymphocytes were the other features helpful in diagnosis. Because of these distinct morphological features, a preoperative diagnosis of spermatocytic seminoma was possible, with subsequent confirmation on histopathology. The case is being reported because of the rarity of this tumor, and because there have been only a few reported cases of FNAC diagnosis. Diagn. Cytopathol. 1999;20:233–236.

Role of iron and iron chelation therapy in oxygen free radical mediated tissue injury in an ascending mouse model of chronic pyelonephritis

The contribution of iron towards the free radical generation leading to renal tissue damage was assessed using a non-obstructive ascending mouse model for chronic pyelonephritis. The parameters studied include luminol dependent chemiluminescence (LDCL), histopathology and some biochemical investigations. We found that iron enhanced the renal tissue damage and led to renal scarring, and end point in chronic renal inflammation, irrespective of the bacterial strain studied. In addition a role of iron chelation therapy as a treatment for chronic renal inflammation is also suggested.

Myoepithelial Cells: Any role in aspiration cytology smears of breast tumors?

Aims and Objective To study the role of myoepithelial (ME) cells in distinguishing benign, proliferative breast diseases (PBD) and frank malignant breast lesions. Materials and methods In this study, histology proven 71 cases of fine needle aspiration cytology (FNAC) of palpable breast lesions were selected. There were 30 invasive carcinomas (24 infiltrating duct carcinoma and 6 infiltrating lobular carcinoma), 25 cases of benign lesion (21 fibroadenomas and 4 fibrocystic lesions) and 11 proliferative breast diseases (other than carcinoma in situ) and five cases of carcinoma in situ. The number of ME cells were estimated in respect to 1000 ductal cells. In every case at least 20 high power fields (× 40) were studied. Quantitative estimation of ME cell was correlated with the final diagnosis. Corresponding histopathology cases were also evaluated for diagnostic confirmation along with the pattern of distribution of ME cells. The ME cells were also quantitated on histopathology sections on smooth muscle actin (SMA) immunostained sections. Results The mean number of ME cells per 1000 ductal cells on cytology smears was 5.1 ± 5.5, 30.8 ± 25, 28.3 ± 20.2, and 38.4 ± 38.8 in malignant, carcinoma in situ, PBD and benign breast lesions respectively. The non parametric Mann Whitney test showed significant difference in number of the ME cells between benign and malignant groups (p < .000), PBD and malignant groups (p < .000) and carcinoma in situ and malignant group (p < .001). However, it was insignificant between benign and PBD group, and PBD and carcinoma in situ (p > .01). In SMA stained histopathology sections, ME cell in benign, PBD, carcinoma in situ and malignant cases were 741.12 ± 248, 238 ± 172, 121.6 ± 115 and 15.6 ± 25.1 respectively. Statistical analysis showed significantly different number of ME cell between benign versus PBD group, carcinoma in situ and malignant group. It was also significant between PBD versus malignant, and carcinoma in situ versus malignant (p < .001, Mann Whitney test). However number of ME cell was not significant between PBD versus carcinoma in situ. Conclusion The number of ME cell in breast lesions may be helpful in distinguishing PBD versus invasive malignant tumors on FNAC smears. However it is not helpful to distinguish benign lesions versus PBD.

Grading of soft tissue sarcomas on fine-needle aspiration cytology smear.

In this present study we have attempted to grade soft tissue sarcomas on fine‐needle aspiration cytology (FNAC) material and then subsequently correlated our findings on histology section.