Veena Chowdhury

Fine-needle aspiration diagnosis of carotid body tumor: report of a case and review of experience with cytologic features in four cases.

A 45‐yr‐old female presented with a left upper cervical swelling of 4 yr duration. The clinical suspicion of carotid body tumor (CBT) was confirmed by imaging findings, fine‐needle aspiration (FNA) cytology, and histology of the resected tumor. Review of our experience with four cases including the present one during 10 yr (1984–1994) showed that the age of the patients ranged from 35 to 45 yr with a mean of 40.8 yr. All four cases were females and had left‐sided upper cervical swelling. Clinically one case was diagnosed as cervical lymphadenopathy and there was clinical suspicion of CBT in two cases. Findings of digital subtraction angiogram in four cases and ultrasonography including Doppler ultrasound vascular imaging in three cases were consistent with CBT. The cytodiagnosis was CBT in three cases and inadequate (blood only) in one case. The analysis of detailed cytologic features in three cases revealed blood‐rich aspirate with poor to moderate cellularity, indistinct cell outline, and acinar formation. Giant bare nuclei, spindle‐shaped tumor cells, and cytoplasmic granulations were observed in two cases each. Histopathology of the resected tumors in two cases confirmed the cytodiagnosis of CBT. FNA cytology played a useful role in arriving at a tissue diagnosis of this rare neoplasm. Diagn. Cytopathol. 17:143–147, 1997.

CD-30(Ki-1)-positive anaplastic large cell lymphoma in a pleural effusion : A case report with diagnosis by cytomorphologic and immunocytochemical studies

BACKGROUND Reports on cytodiagnosis of Ki-1-positive anaplastic large cell lymphoma (ALCL) are rare. This report describes one such case diagnosed by cytologic examination of a pleural effusion and confirmed by immunocytochemistry. CASE An 87-year-old male presented with breathlessness, fever and a cough. Computed tomographic scan of the thorax showed a small, right, pleura-based nodule with infiltration of the immediate surroundings in addition to a massive, right-sided pleural effusion. Cytologic examination of pleural fluid revealed a heterogeneous population of cells comprising small mature lymphocytes, and numerous medium and large atypical lymphoid cells having frequent nuclear irregularity. Occasional very large cells resembling Reed-Sternberg cells or multinucleated cells with a horseshoe or wreathlike arrangement of nuclei (doughnut cells) were also present. Cytomorphology was suggestive of Ki-1 anaplastic large cell lymphoma (ALCL). Immunocytochemistry revealed intense positivity for CD-30, positivity for LCA and EMA in a variable number of cells and a negative result for cytokeratin except for occasional cells. CONCLUSION Cytologic examination of pleural fluid can serve as a useful tool for the initial diagnosis of Ki-1-positive ALCL.

Evaluation of the Role of Magnetic Resonance Spectroscopy in the Diagnosis of Follicular Malignancies of Thyroid

OBJECTIVES To evaluate role of magnetic resonance spectroscopy in differentiating benign from malignant follicular nodules. DESIGN Prospective study. SETTING Department of Surgery in collaboration with Department of Radio Diagnosis, Maulana Azad Medical College, Delhi, India. PATIENTS Twenty-five patients with a solitary thyroid nodule with follicular etiology. INTERVENTIONS Magnetic resonance spectroscopy was carried out in all the cases, and its findings were compared with the final diagnosis based on histopathological examination of sample obtained at surgery. MAIN OUTCOME MEASURES Choline peak detected on MRS. RESULTS There were 17 benign cases, 16 follicular adenomas, and 1 colloid goiter. Of the 17 benign cases, only 1 showed choline peak; however, all 8 follicular carcinoma cases showed prominent choline peak. Hence, the sensitivity is 100% while the specificity is 94.11%. CONCLUSION Magnetic resonance spectroscopy may prove to be a sensitive diagnostic tool in differentiating follicular adenomas from carcinomas.

Oral Leiomyosarcoma in Childhood

BACKGROUND: Leiomyosarcomas are rare tumors in the pediatric age group, and occurrence of this neoplasm in the oral cavity is exceedingly rare. This article highlights the fine needle aspiration (FNA) cytology diagnosis of a case of recurrent oral leiomyosarcoma in childhood. CASE: An 11-year-old male noticed a swelling in the oral cavity near the left lower jaw. It was excised and diagnosed as leiomyosarcoma on histopathology. Four months later the patient presented with a progressive swelling in the oral cavity that extended to the lower jaw. The recurrent swelling was subjected to FNA, and its cytologic features were consistent with leiomyosarcoma. There was a very good initial response to chemotherapy and radiation therapy. However, because of noncompliance with advice for further therapy, the patient had a second local recurrence and dissemination of the disease to the skeletal system, abdomen and thorax. FNA cytology diagnosis of the second locally recurrent lesion and abdominal mass were consistent with leiomyosarcoma. Immunocytochemical staining revealed a positive reaction in the cytoplasm of tumor cells for vimentin and desmin in the FNA smear and paraffin section, respectively. CONCLUSION: Fine needle aspiration cytology is a useful technique for detection of recurrence and metastasis during follow-up of childhood oral leiomyosarcoma.

Cortical excitability in drug naive juvenile myoclonic epilepsy

PURPOSE To evaluate the effect of diurnal variability on cortical excitability using single pulse transcranial magnetic stimulation (TMS), in drug naive patients with juvenile myoclonic epilepsy (JME) and to look for any differences in cortical excitability between males and females. METHODS Thirty drug-naive patients with JME and 10 healthy controls were studied. Resting motor threshold (RMT), motor evoked potential (MEP), the duration of central motor conduction time (CMCT) and cortical silent period (CSP) were measured, twice, first early in the morning and again in the afternoon of the same day. RESULTS Diurnal variation with higher evening values of CMCT and CSP were observed in the control group. In the study group, diurnal variation in RMT, CMCT and CSP was found with higher values in the morning than in control group. However, only the raised values of CSP [mean, 110.7ms, morning and 96.44ms, evening] were of statistical significance [p=0.005, morning and 0.039, evening] as compared to controls. In the study group, males had higher values of RMT, CMCT and CSP than in females. However, the CMCT in males was lower in the evening study than in females. Further, RMT and morning CMCT was lower in females than in controls. In females, the morning CSP [mean, 100.91ms, morning versus 87.86ms, evening] was significantly prolonged [p=0.017, morning versus 0.221, evening] as compared to controls. CONCLUSION The study is suggestive of the existence of impaired supraspinal/intracortical inhibitory circuits which may account for the hyperexcitability of the motor system being prominent in the morning among drug naïve patients with JME. In this study, increased activity of cortical inhibitory networks, as evidenced by prolonged cortical silent period existed among drug naïve JME patients, but was found to be significant only in female patients. This may explain the increased seizure susceptibility in this cohort, at this time of the day and an increased manifestation of JME in females.

Deferiprone-induced arthropathy in thalassemia: MRI findings in a case.

Arthropathy is a well known side effect of the iron chelator deferiprone (L1); however, the imaging findings in deferiprone-induced arthropathy are not well known. In this article, we describe the typical radiographic and MRI findings in a patient receiving regular blood transfusions who developed arthropathy after long-term therapy with the oral iron chelator deferiprone (L1). Deferiprone primarily affects the articular cartilage and the changes include synovial thickening, articular cartilage thickening, and subchondral bone erosions.

Myoclonus: a manifestation of neurocysticercosis.

A case of neurocysticercosis in an 11 year old female manifesting only as myoclonic seizures is reported. The diagnosis was based upon ELISA test, computed tomography, and biopsy of a subcutaneous nodule. The patient responded to anticysticerci drug treatment. Neurocysticercosis has not to our knowledge been previously reported to have presented with myoclonus.

Study of pulmonary function tests in thalassemic children.

The present study aimed to investigate pulmonary function tests (PFTs) in children with thalassemia and to assess the relation between the degree respiratory impairment with the body iron status. High resolution computed tomography of chest (CHRCT) and bronchoalveolar lavage (BAL) was performed to study the cause of pulmonary dysfunction. Thirty-one children with thalassemia over 8 years were included. PFTs were studied including lung volumes and carbon monoxide diffusion capacity (DLco). Patients with abnormal PFTs and/or impaired DLco were further subjected to CHRCT and BAL. Total cell count was measured; differential count was performed on Giemsa and PAP smears. Iron laden macrophages were identified on Perls stain. PFTs were normal in 51.61%, diffusion capacity impaired in 41.16%, restriction in 16.12%, while obstruction in 3.22% of cases, respectively. There was significant inverse correlation between DLco and serum ferritin. Through multivariate regression analysis, ferritin was found to be a strong predictor for forced vital capacity and total lung capacity. Bronchial dilatation and areas of air trapping were the predominant CHRCT findings. Iron laden macrophages were demonstrated in 14 of 15 patients in BAL. A significant correlation between serum ferritin and DLco, forced vital capacity, total lung capacity, and the presence of iron laden macrophages in BAL indicates that iron plays a major role in the etiopathogenesis of these abnormalities.

Case report: Isolated unilateral pulmonary vein atresia diagnosed on 128-slice multidetector CT

Unilateral pulmonary venous atresia is an uncommon entity that is generally believed to be congenital. Most patients present in infancy or childhood with recurrent chest infections or hemoptysis. Pulmonary angiography is usually used for definitive diagnosis. However, the current multislice CT scanners may obviate the need for pulmonary angiography. We report two cases diagnosed using 128-slice CT angiography. On the CT angiography images both these cases demonstrated absent pulmonary veins on the affected side, with a small pulmonary artery and prominent bronchial or other systemic arterial supply.

Role of dynamic MRI in differentiating benign from malignant follicular thyroid nodule.

OBJECTIVES Thyroid nodular swellings are very common, consisting of both benign and malignant ones. Fine needle aspiration cytology is an excellent diagnostic modality for papillary cancers, medullary cancers, colloid goiter and lymphoma but fails in differentiating follicular adenomas from carcinomas. The purpose of this study was to evaluate role of Dynamic MRI with signal intensity time curve evaluation in differentiating benign from malignant follicular nodules. MATERIALS AND METHODS This study was carried out in Department of Surgery in collaboration with department of Radiodiagnosis, Maulana Azad Medical College, Delhi. 28 patients with solitary thyroid nodule (STN) having follicular etiologies were included in the study. Dynamic MRI with signal intensity time curve analysis was carried out in all the cases and findings were compared with the final diagnosis based on histopathological examination of surgical specimen. RESULTS In the present study, rapid enhancement was seen in 87.5% of malignant cases and washout pattern was seen in 87.5% of malignant STN (p=0.019). Only 20% of the benign lesions showed washout pattern (p=0.0034). Benign cases demonstrated gradual enhancement in 85% cases as compared to 12.5% in malignant STN (p=0.0098). CONCLUSION This study suggests that signal intensity time curve may help in differentiating benign from malignant follicular thyroid nodules.