Sukant Garg

Role of fine needle aspiration cytology in diagnosis and ­management of thyroid lesions: A study on 434 patients

Objectives: To evaluate the results of fine needle aspiration cytology (FNAC) in the diagnosis and management of thyroid lesions. Materials and Methods: A review was conducted of FNAC of diffuse or nodular thyroid lesions performed on 434 patients over a period of three years. The cytological results were correlated with clinical features, biochemical investigations, and subsequent histopathological examination and management of the patients. Results: The most frequently encountered lesion was the colloid goiter in 250 (57.60%) cases followed by thyroiditis in 119 (27.41%) cases, ten (2.30%) adenomatous goiters and two (0.004%) thyroglossal cysts. In the neoplastic group, 14 (1.38%) cases were reported as follicular/Hurthle cell neoplasms and 17 (3.91%) as malignant tumors. When compared with the clinical diagnosis, FNAC proved to be an improvement on the diagnosis of thyroiditis and malignancy when compared with that of goiter. FNA revealed a sensitivity of 97%, a specificity of 100%, a positive predictive value of 96% and a negative predictive value of 100%. Conclusions: FNAC is a minimally invasive, highly accurate and cost-effective procedure for the assessment of patients with thyroid lesions. It also helps in differentiating lesions that require surgery from those that can be managed otherwise.

Fine‐needle aspiration cytology of Sister Mary Joseph's (paraumbilical) nodules

During a period of 5 years (2001–2005), six cases of Sister Mary Josephs nodule (umbilical metastasis) were diagnosed by fine needle aspiration cytology (FNAC). In all the cases, FNAC of umbilical nodules was the first investigation and subsequently the patients were investigated for the primary tumor. The primary carcinoma was found in the stomach in three cases, ovary in two cases and one case was of non‐Hodgkins lymphoma. Based on our findings, we suggest FNAC as an initial diagnostic procedure in cases suspected of umbilical metastasis. It is not only simple, fast, accurate and inexpensive but can also save the patient from other invasive diagnostic procedures. Diagn. Cytopathol. 2008;36:348–350.

Sarcomatoid carcinoma of the cervix: case report of a rare entity

BackgroundSarcomatoid carcinoma of the cervix is a rare entity. To date, less than 20 cases have been reported in the English literature.CaseWe present a case of a 75-year-old multigravida woman who was treated with radiation therapy.Conclusion It is an aggressive tumour and primary treatment with radiation in early stage disease offers an effective form of therapy.

Kimura's disease: clinicopathological study of eight cases

BACKGROUND Kimuras disease is a rare, localised, chronic inflammatory disease. This benign disease involves subcutaneous tissues, the major salivary gland, and lymph nodes primarily in the head and neck area. METHOD Clinical details and stained slides of all cases reported as Kimuras disease over a 10-year period were reviewed. RESULTS There were eight cases of Kimuras disease. The mean age of patients was 22.8 years. One case showed associated nephrotic syndrome and two cases were associated with peripheral blood eosinophilia. All cases showed the typical histopathological features of Kimuras disease. CONCLUSION Kimuras disease was first reported in China in 1937. The cause of Kimuras disease is unknown and many theories have been proposed. The eight cases reported here illustrate some of the variations in the mode of presentation and in the histological features of Kimuras disease. Kimuras disease should be considered in the differential diagnosis of patients who present with head and neck swellings and lymphadenopathy, and investigated accordingly.

Fine needle aspiration cytology in the diagnosis of abdominal TB: a review of 92 cases

During a period of eight years (1999–2006), 92 cases of abdominal TB were diagnosed by fine needle aspiration cytology (FNAC). Based on our findings, FNAC is a simple, fast, accurate and inexpensive diagnostic procedure for cases of suspected abdominal TB.

Aspiration cytology of rheumatoid nodules: report of two cases

Dear Editor, Rheumatoid nodules, solitary or multiple, develop as a part of the disease process in rheumatoid arthritis (RA). In some clinical situations, morphologic confirmation of these nodules may be necessary to rule out other lesions. This is usually done by tissue biopsy; fine needle aspiration (FNA) has rarely been reported and only as isolated case reports. Here, we describe the cytological findings in two cases presenting as subcutaneous nodules. A 52-year-old woman, a known case of rheumatoid arthritis on treatment, came with swelling of the right wrist joint for 5 years. On local examination, a nodule 2.5 cm diameter was felt on ventral aspect of the right wrist joint. On investigations, erythrocyte sedimentation rate (ESR) was 40 mm first hour (Wintrobe s method) with a positive RA factor. Renal function tests, fasting blood sugar and urine examination did not show any abnormality. A clinical diagnosis of either amyloidosis or rheumatoid nodule was made. The second case, a 40-year-old female, presented with bilateral swellings on both hands and the left elbow joint for 5 days. On local examination, there were nodular swellings on both hands. A 2 cm nodule was also palpable on front of the left elbow joint. The ESR was 55 mm first hour (Wintrobe s method), RA factor was negative, while renal function tests, fasting blood sugar and urine examination did not show any abnormality. X-rays of the hands and elbow joint showed changes of RA. A clinical diagnosis of erythema nodosum or rheumatoid nodule was made. FNA of the nodule in both cases was performed using a 23-gauge needle and 20 ml syringe. Air-dried smears prepared from the aspirate were stained with May-Grunwald–Giemsa while wet-fixed smears were stained with haematoxylin and eosin as well as Papanicoloau stains. The smears from both the cases revealed lymphocytes, plasma cells, histiocytes and multinucleated histiocytic giant cells. Occasional granulomas with a central metachromatic, acellular, necrotic area surrounded by palisade of elongated cells were also seen (Figure 1). The histopathological examination of biopsy material done in the second case confirmed the cytological diagnosis of rheumatoid nodule. Cytomorphology in both cases confirmed the fact that properly performed aspiration could provide sufficient cell-rich specimens. Regardless of location, the differential diagnosis in cytological material includes sarcoidosis, tuberculosis, fungal infections, granuloma annulare and rheumatic fever. The clinical history, special stains such as Ziehl-Neelsen and mucin stains and ancillary techniques, i.e. culture and PCR help in differentiating between these lesions. Rarely FNA of a rheumatic nodule may yield prominent cellular atypia of spindle cells, with large hyperchromatic nuclei and large nucleoli. This