Sujata Chaturvedi

Significance of Cytologic Criteria in Distinguishing Small Cell from Non–Small Cell Carcinoma of the Lung

OBJECTIVE To study the significance of cytologic features in distinguishing small cell carcinoma (SCC) from non-small cell carcinoma (NSCC). STUDY DESIGN Prospective study of 76 patients with lung carcinoma. Percutaneous fine needle aspiration and bronchial washings stained with Papanicolaou and May-Grünwald-Giemsa stain were used for categorization of tumors according to the World Health Organization classification. Each tumor was also scored for the presence or absence of standard cytologic criteria used in the diagnosis of SCC. Data were analyzed for sensitivity, specificity and significance using the chi 2 and Fisher exact tests. Undifferentiated and unclassified tumors were examined immunocytochemically for the presence of neuron-specific enolase, epithelial membrane antigen and leukocyte common antigen. Cytologic diagnoses were compared with histopathologic diagnoses. RESULTS Seventy-six lesions classified on cytomorphology consisted of SCC (15), NSCC (50), non-Hodgkins lymphoma (1), carcinoid (1) and undifferentiated or poorly differentiated carcinomas (9), 2 of which showed nuclear molding and salt-and-pepper chromatin. Immunocytochemistry and biopsy confirmed the diagnosis of SCC in those two patients. CONCLUSION Nuclear molding, cell size and scant, basophilic cytoplasm were highly sensitive and specific by univariate analysis for distinguishing SCC from NSCC. Other features, such as salt-and-pepper chromatin, crush artifact and apoptotic bodies, also had significantly high specificity; however, their low sensitivity precluded their usefulness in separating SCC from NSCC. Thus, morphologic evaluation plays a major role, while immunocytochemistry can make a limited contribution in differentiating SCC from NSCC.

Fine Needle Aspiration Diagnosis of a Subcutaneous Abscess from Enterobius vermicularis Infestation

BACKGROUND: Extraintestinal infestation by Enterobius vermicularis is uncommon. It has been reported to occur in the peritoneal cavity, ovary, fallopian tube, endometrium, lung, liver and urinary tract. CASE REPORT: Fine needle aspiration diagnosis was made in a case of enterobiasis presenting with a subcutaneous abscess in the natal cleft. Eggs, as well as fragments of cuticle of the adult worm, were found; the morphology of both was best visualized in Papanicolaou-stained smears. Polarizing microscopy highlighted the equally spaced parallel grooves of the cuticle. CONCLUSION: Fine needle aspiration cytology of subcutaneous abscesses due to enterobiasis can be diagnostic when eggs, or eggs with cuticle, are identified in a suppurative or granulomatous inflammation.

Effect of electroconvulsive therapy on hematological parameters

Although a complete blood count is part of the evaluation before the use of electroconvulsive therapy (ECT), there are no known hematological contraindications for the procedure. A preliminary study was done on 31 randomly selected psychiatric patients (chronic schizophrenia, n=10; acute depression, n=8; acute mania, n=6; acute psychosis, n=6; delusional disorder, n=1) receiving ECT to study its hematological effects. Blood samples were drawn just before and 0, 1 and 2 h after ECT. Hemoglobin (Hb%), total and differential leukocyte count (TLC and DLC), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and platelet count were measured on a fully automated hematology analyzer (Sysmex K-1000). Significant changes were found in TLC, percentage of polymorphs and lymphocytes, and Hb%. Changes in other parameters were not statistically significant. More such studies are needed to substantiate these observations and to understand the mechanism and implication of these effects.

Extra-axial medulloblastoma in the cerebellopontine angle: Report of a rare entity with review of literature

With only 33 cases reported so far, a purely extra-axial position of medulloblastoma at cerebellopontine (CP) angle is quite exceptional. We report a case of extra-axial medulloblastoma in a 15-year-old male child located in the CP angle that was surgically treated with a provisional diagnosis of schwannoma. Histopathological diagnosis of medulloblastoma was made with the routine hematoxylin and eosin stain and immunohistochemical markers. This case report highlights the fact that although extremely rare, the possibility of an extra-axial mass being a medulloblastoma does exist.

Central nervous system tumors: Radiologic pathologic correlation and diagnostic approach.

Objective: This study was conducted to formulate location-wise radiologic diagnostic algorithms and assess their concordance with the final histopathological diagnosis so as to evaluate their utility in a rural setting where only basic facilities are available. Materials and Methods: A retrospective analysis to assess the concordance of radiology (primarily MRI) with final histopathology report was done. Based on the most common incidence of tumor location and basic radiology findings, diagnostic algorithms were prepared. Results: For supratentorial intraaxial parenchymal location concordance was seen in all high-grade astrocytomas, low- and high-grade oligodendrogliomas, metastatic tumors, primitive neuroectodermal tumors, high-grade ependymomas, neuronal and mixed neuro-glial tumors and tumors of hematopoietic system. Lowest concordance was seen in low-grade astrocytomas. In the supratentorial intraaxial ventricular location, agreement was observed in choroid plexus tumors, ependymomas, low-grade astrocytomas and meningiomas; in the supratentorial extraaxial location, except for the lack of concordance in the only case of metastatic tumor, concordance was observed in meningeal tumors, tumors of the sellar region, tumors of cranial and paraspinal nerves; the infratentorial intraaxial parenchymal location showed agreement in low- as well as high-grade astrocytomas, metastatic tumors, high-grade ependymoma, embryonal tumors and hematopoietic tumors; in the infratentorial intraaxial ventricular location, except for the lack of concordance in one case of low-grade astrocytoma and two cases of medulloblastomas, agreement was observed in low- and high-grade ependymoma; infratentorial extraaxial tumors showed complete agreement in all tumors of cranial and paraspinal nerves, meningiomas, and hematopoietic tumors. Conclusion: A location-based approach to central nervous system (CNS) tumors is helpful in establishing an appropriate differential diagnosis.

Intramedullary meningioma of spinal cord: Case report of a rare tumor highlighting the differential diagnosis of spinal intramedullary neoplasms

A 15-year-old male presented with progressive weakness of both lower limbs with urinary incontinence. Magnetic resonance imaging revealed a spinal intramedullary mass at D7-D8 level. The child was operated with a preliminary diagnosis of an intramedullary tumor. Atypical ependymoma and astrocytoma were considered in the differential diagnosis. Per- and post-operative histopathological examination reported the case as transitional meningioma (WHO Grade I). Spinal intramedullary meningiomas being a rare entity may be confused with other common intramedullary tumors. Though, rare still the possibility of an intramedullary spinal mass of being a meningioma does exist and therefore should be considered in the differential diagnosis of intramedullary tumors.

Spinal cysticercosis: A report of two cases with review of literature

Neurocysticercosis is the most common parasitic infection of the central nervous system worldwide. However, Cysticercosis affecting the spine is considered extremely rare. We report two cases of spinal cysticercosis with review of literature.

Intravascular lymphoma: an unusual cause of rapid cognitive decline and the role of brain biopsy

Intravascular lymphoma (IVL) is a rare extra nodal variant of non Hodgkins lymphoma characterised by neoplastic lymphoid cells growing inside the lumina of medium and small vessels. IVL limited to the central nervous system (CNS) is an extremely rare condition as IVL is usually found with systemic lesions. Most cases of IVL are not diagnosed until post mortem because of variable clinical presentation and non-specific laboratory findings. Even if diagnosed early the disease is clinically aggressive and usually fatal, even with early detection and treatment. We present a case of a 37-year-old woman with a short history of behavioural abnormality, rapidly progressive cognitive decline and seizures. There were no cutaneous manifestations. Diagnosis was established only after the brain biopsy. The case is presented for the rarity of its presentation and role of brain biopsy in diagnosis.

A Trend Analysis of Quality Indicators of Patient Safety in the Clinical Laboratory Over 21 Months

Objectives To evaluate the quality indicators covering the critical steps in the pre- and postanalytical phases and to study their trends over a 21-month period in the laboratory. Methods A prospective analysis of results obtained from our clinical chemistry and haematology laboratories, which function independently, for errors in the pre- and postanalytical phases was carried out to observe the trend for all the errors after the implementation of 3 patient-safety strategies. Results A significant improvement was observed in completeness of test requisition forms (TRFs) received in the laboratory after staff training. Incidence of sample rejection decreased dramatically after the implementation of a second patient-safety activity; it dropped further after the introduction of evacuated tubes. Almost 100% improvement was observed in critical and urgent reporting. Conclusion Use of quality indicators to assess and monitor clinical-laboratory processes is an extremely valuable tool in maintaining quality control in a systematic and transparent way. * IOM : Institute of Medicine TTP : total testing process TRF : test requisition form IQC : internal quality control SOPs : standard operating procedures LIS : laboratory information system

Immunohistochemistry on squash smears: A diagnostic aid

Dear Dr. Bedrossian: The intraoperative review of biopsy samples from central nervous system is one of the most important tasks performed by the neuropathologist. Proper tissue handling is particularly crucial at this stage of patients care. For almost all tumors, regardless of the sample size, three types of specimens are prepared: cytologic specimens, frozen tissue sections, and permanent formalin-fixed, paraffin-embedded tissue sections. Among the intraoperative cytologic preparations, touch, squash, scrape, or drag smears can provide morphologic details that complement the information provided by the frozen sections. The standard routine diagnostic algorithm followed in most neuropathology laboratories, the world over, involves H&E staining, ‘‘special stains’’ namely toluidine blue, methylene blue, or Diff–Quik stain and immunohistochemistry. The latter, in the authors experience, is often limited by the presence of excessive necrosis, hemorrhage, or congestion seen in the bit processed for hematoxylin and eosin sections. In such situations, viable material present in the squash smears can be used for immunohistochemical profiling and, therefore, complementing the findings on routine examination. The procedure followed in our laboratory was squash smear preparation and immunostaining (Table I). This technique has shown specific positivity with neither any background staining nor any interpretation problem. Table I. Showing the Methodology for Staining the Squash Smear for Glial Fibrillary Acidic Protein (GFAP)