Incidental Cytodiagnosis of Carotid Body Tumour on Fine Needle Aspiration Cytology.

A carotid body tumor is a rare form of neoplasm that arises near the carotid artery bifurcation and it has an incidence rate of less than 0.3 per 100,000 population. The low incidence rate of such tumors is due to their origination from the paraganglion cells which is relatively uncommon as compared to other forms of tumor. Here we present an incidental and unusual cytodiagnosis of carotid body tumors. A 45-year-old male presented to the surgery outpatient department with swelling in the left-sided anterior region of the neck. The swelling was gradually progressing over three years and was insidious. Clinically the swelling was 3 cm x 3 cm in size and the patient complained of pain in the last two months which was intermittent. The patient was sent to the cytopathology section for fine needle aspiration cytology with the clinical diagnosis of tubercular lymphadenopathy. The patient underwent fine needle aspiration cytology by 26 SW needle by standard institutional protocols. The cytodiagnosis of "Paraganglioma/ Carotid Body Tumour" was offered. Histomorphological features at excision were consistent with carotid body tumors (paraganglioma). The sections of the tumor immunohistochemically were positive for neuron-specific enolase. The incidental cytodiagnosis of carotid body tumors is reported in the literature sparsely. This case is presented for the cytomorphology of carotid body tumor which is unfamiliar to the reporting pathologist because of its rare occurrence.

The Cytodiagnosis of Amelanotic Primary Signet Ring Cell Melanoma at the Unusual Site of the Axilla: A Case Report of a Rare Entity.

Amelanotic primary signet ring cell melanoma is a rare variant of cutaneous malignant melanoma. The diagnosis of amelanotic primary signet ring cell melanoma is rarely made based on cytological examinations. Most of the cases reported in the routine practice involve metastatic lesions of known cutaneous amelanotic primary signet ring cell melanoma. The diagnosis of amelanotic primary signet ring cell melanoma on fine needle aspiration cytology (FNAC) is scarce. We present one such extremely rare diagnosis of amelanotic primary signet ring cell melanoma at the unusual site of the axilla, which was established on FNAC. We also discuss its histological differential diagnosis and confirmative immunohistochemistry (IHC).

Utility of Perl's Prussian Blue Stain in Exfoliated Buccal Cells of Thalassemia and Sickle Cell Anemia Patients and Their Correlation With Serum Ferritin Levels.

Introduction Iron is essential for all living beings. Excess iron, on the other hand, is dangerous because it causes the creation of free radicals. As a result, iron absorption is carefully managed to maintain a balance between absorption and iron loss in the body. Due to the lack of particular excretory channels for iron in humans, iron excess in the tissues is common. It can be caused by a number of factors, including increased iron absorption, as seen in hemochromatosis, or frequent parenteral iron treatment, as seen in thalassemia and sickle cell anemia patients (a transfusional overload). Aim The study aims to demonstrate Perl's Prussian blue stain to identify iron overload at a preliminary stage and correlate with serum ferritin levels in patients with thalassemia and sickle cell anemia who frequently receive blood transfusions. Materials and methods The present study comprised 62 confirmed cases of thalassemia and sickle cell anemia patients undergoing repeated blood transfusions of a minimum of 15/more, along with 62 clinically healthy individuals between December 2016 and November 2018. The patients with thalassemia and sickle cell anemia were confirmed by hemoglobin electrophoresis (Bio-Rad D-10, Bio-Rad Laboratories, Inc, California, United States). The buccal smears were obtained from these patients along with the controls, and these slides were stained by Perl's Prussian blue stain and were examined under a light microscope. Results Sixty-two cases and 62 controls were considered in the current investigation. Forty-seven of the 62 people had thalassemia, and 15 had sickle cell anemia. Thirty-nine out of the 47 patients with thalassemia and six of the 15 individuals with sickle cell anemia had positive results for Perl's Prussian blue stain. All patients had elevated blood ferritin levels, with varying ranges associated with positive results for Perl's Prussian blue stain. Conclusion The objective of this study was to demonstrate the utility of oral exfoliative cytology in thalassemia and sickle cell anemia patients who often receive blood transfusions as a screening and diagnostic tool. The exfoliative cytology methods' acceptability and simplicity, along with their correlation with serum ferritin levels and Perl's Prussian blue reaction, make this noninvasive procedure an excellent screening and diagnostic tool for all patients who receive repeated blood transfusions.

Hemoglobin Variants in Patients With Microcytic Hypochromic Anemia: A Review of Indian Studies.

Microcytic hypochromic (MCHC) anemia with hemolytic components is common in clinical practice. Hemoglobinopathies and variants are one of the important underlying causes of MCHC anemia. The Indian population, by large, as various studies reported, showed a plethora of hemoglobinopathies with regional predilections for its types. The present systematic review is carried out for the evaluation of MCHC anemia for its underlying causes of hemoglobinopathies and their loco regional comparisons. The review was carried out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method with selected keywords through the Google advanced search matchable to the objectives of the present systematic review. Upon the systematic review, it was observed that ß thalassemia trait (ßTT) remained the highest reported hemoglobinopathy. The other abnormal hemoglobin variants, though rare, also have been reported in the reviewed articles. It is concluded that patients with MCHC refractory to its regular treatment should be subjected to high-performance liquid chromatography (HPLC) in exclusion of underlying hemoglobinopathy and abnormal hemoglobin variants.

Invasive Acantholytic Ocular Surface Squamous Neoplasia: A Rare Case.

Ocular surface squamous neoplasia (OSSN) is a spectrum of intraepithelial and invasive neoplastic lesions of the conjunctiva and cornea. OSSN is a rare but potentially sight-threatening ocular malignancy that can be challenging to diagnose due to its clinical and histopathological resemblance to benign ocular surface lesions. However, OSSN can lead to significant ocular and systemic morbidity, including vision loss and metastasis. Various risk factors have been identified, including ultraviolet radiation exposure, human papillomavirus infection, and immunosuppression. The histopathological analysis of the lesion is of utmost importance in diagnosing and further managing squamous cell carcinoma. The acantholytic variant of squamous cell carcinoma is uncommon. Here, we present the case of a 69-year-old male who presented with an invasive mass of progressive growth on the left eyeball extending into the visual axis. The patient underwent extended enucleation, and a histopathological analysis demonstrated a rare acantholytic variant of squamous cell carcinoma.

Cytodiagnosis of Basal Cell Adenoma of Parotid Gland: A Rare Case Report.

Basal cell adenoma is a rare benign neoplastic lesion of the parotid gland, therefore it is rarely diagnosed in preoperative work-up by fine needle aspiration cytology. This distinctive entity being regarded as one of the scarce salivary neoplasms is predominantly perceived in the female population, but is uncommon in young adults. It is extremely challenging to diagnose basaloid tumors predominantly basal cell adenoma of the salivary gland on cytopathology. Therefore present case report describes the fine needle aspiration cytology diagnosis of basal cell adenoma in the left parotid gland in a 40-year-old female. The case report also describes the cytomorphological characters, the cytological differential diagnoses and immunohistochemistry of basal cell adenoma.

Management of Uterine Fibroids and Its Complications During Pregnancy: A Review of Literature.

The word "uterine fibroids" itself indicates these are leiomyomas (a group of smooth muscle tumors that are benign), generally growing in the wall of the uterus. Nowadays, this is one of the most common diseases in women in the premenopausal age group. According to the studies, uterine fibroids are more commonly observed in women of African ancestry than white women. This article aims to educate readers on some fundamental concepts regarding uterine fibroids, such as the different types of fibroids according to various classification schemes, as well as their etiology, epidemiology, pathogenesis, management, and treatment, all of which must be understood by anyone studying medicine or working in the medical field. Along with reviewing current management options for uterine fibroids, it also identifies areas needing additional study to identify novel therapeutic targets and improve treatment individualization.

Cytodiagnosis of unusual metastases in parotid gland.

Documentation of metastatic lesions in the parotid gland diagnosed by fine-needle aspiration cytology (FNAC) is limited in the cytopathology literature. The metastases within the parotid masquerades clinically as primary neoplasm of parotid. The authors of present case report intent to highlight the importance of FNAC in the diagnosis of metastases in parotid. These diagnoses enable the search for the locations of unknown primaries. The nodules within the parotid masquerading as primary neoplasm have undergone FNAC in five cases. The cytomorphological interpretation of the smears was performed. The diagnosis on cytology was compared with subsequent histological evaluation of the suggested primary neoplasm. FNAC in the five cases revealed the following cytodiagnosis: metastases of ductal carcinoma (2), melanoma (1), deposits of small cell carcinoma (1) and metastases of clear cell renal cell carcinoma (RCC) (1). There was complete concordance when these cytodiagnoses were compared with histological evaluation from the suggested sites of primaries as well-differentiated ductal carcinoma of the breast (2), melanoma of the scalp (1), small cell carcinoma of the lung (1) and clear cell RCC of the kidney (1). The metastases within the parotid can masquerade as primary neoplasm. The cytomorphological patterns and features of metastases are similar to that of their primary neoplasm. Therefore, FNAC over the nodules within the parotid unsuspected for metastases provides valuable information to search for primary neoplasm.

Comparison of Estrogen and Progesterone Receptor Status in Tumor Mass and Axillary Lymph Node Metastasis in Patients with Carcinoma Breast.

INTRODUCTION: Breast malignancy is a hormone-dependent tumor. The hormone receptor status in the primary tumor is required while taking decision for starting adjuvant therapy. The estrogen receptor (ER) and progesterone receptor (PR) status is also an important prognostic marker. MATERIALS AND METHODS: All modified radical mastectomy cases with axillary lymph node dissection were taken. H and E staining was done. All lymph node-positive breast cancer cases were subjected to immunohistochemistry using ER and PR antibodies. RESULTS: In the study of 60 cases, the level of concordance between the primary tumor and the metastatic lymph node was 98.33% for ER and 96.66% for PR. CONCLUSION: There exists a positive correlation between the hormone receptor status of the primary tumor and the paired axillary lymph nodes.

Intraoperative Surgical Margin Clearance - Correlation of Touch Imprint Cytology, Frozen Section Diagnosis, and Histopathological Diagnosis.

INTRODUCTION: Touch imprint cytology (TIC) and frozen section diagnosis are valuable intraoperative guides for the management of malignancies as they make a prompt therapeutic decision that may prevent surgical re-intervention. The present study emphasizes on the correlation of TIC and frozen section for the evaluation of surgical margins considering histopathological diagnosis as the gold standard. AIM: The aim of the study was to assess the accuracy of frozen section diagnosis and TIC in the evaluation of surgical margin clearance. MATERIALS AND METHODS: It is a prospective analytical study of 103 patients carried in the histopathology section of department of pathology for 1 year from July 2017 to July 2018. Specimens were received in the frozen section room, grossed by the standard protocol. Touch imprints of margins were taken, and frozen sections were stained by rapid hematoxylin and eosin stain. The same margins were sent for permanent histopathology sections. RESULTS: Of 103 patients, 51 (49.51%) were oral squamous cell carcinoma, 35 (33.98%) carcinoma breast, 9 (8.74%) carcinoma colon, 4 (3.88%) squamous cell carcinoma of skin, 3 (2.91%) basal cell carcinoma, and 1 (0.97%) malignant peripheral nerve sheath tumor. Frozen section diagnosis for margin clearance of the above organs showed that the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were found to be 100%, 98.71%, 100%, 100%, and 99.02%, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of TIC for surgical margin clearance were 46.15%, 100%, 100%, 84.62%, and 86.40%, respectively. CONCLUSION: Frozen section diagnosis is an accurate method for the assessment of surgical margin clearance as compared to TIC. This study evaluated predominantly epithelial malignancies than mesenchymal malignancies, thus emphasizing its utility in it. More research needs to be done for the assessment of the utility of these lesions.

Cervical lymphadenopathy in a dental patient: An eye opener case report.

Cervical lymphadenopathy, a condition with multifactorial etiology is one of the common presentations in patients reporting to dental clinic. It is thus imperative that oral physicians have to be well versed with the causes of cervical lymphadenopathy. The present article describes a case of 24-year-old male who reported to his dentist with complaint of painless swelling of 4 months duration on right side of neck. Oral examination revealed missing mandibular third molars on both sides, which was confirmed on radiograph. Considering reactive lymphadenitis secondary to inflamed impacted molar as a reason for neck swelling, the surgical removal of third molar of right side was performed under antibiotic coverage which was uneventful. As the neck swelling persisted even after removal of molar, patient had undergone fine needle aspiration cytology and then the swelling was diagnosed as tubercular lymphadenitis. He was treated by antitubercular therapy for 6 months regimen, after then he was perfectly alright. The present report aims to highlight contemplative role of oral physician in early diagnosis of neck swellings that can result in on-time management.

Reactive Lymphoid Hyperplasia or Tubercular Lymphadenitis: Can Real-Time PCR on Fine-Needle Aspirates Help Physicians in Concluding the Diagnosis?

BACKGROUND: Enlarged lymph nodes in adult patients often present a diagnostic challenge. In the absence of granuloma or necrosis, the cytology/tissue findings are misleading and relate the enlarged lymph nodes to reactive lymphoid hyperplasia (RLH), because granuloma formation is an immunological response that usually takes 14-100 days to develop. This study assesses the role of real-time (RT)-PCR in the diagnosis of the Mycobacterium complex (MTBC) in lymph node aspirates compared with culture in cases of RLH. METHODS: A cross-sectional study was conducted on 112 patients, aged 15-74 years, with a diagnosis of RLH on cytology. RT-PCR for MTBC detection and culture on Löwenstein-Jensen medium for tubercular bacilli was done on lymph node aspirates. Comparative values with reference to culture were calculated. The χ2 value, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) were calculated. RESULTS: Out of 112 RLH cases, 35 (31%) were positive on both RT-PCR and culture. RT-PCR was positive in 43 cases and culture was positive in 44 cases. The χ2 test was found to be highly significant. PPV, NPV, positive LR, and negative LR were 81.4%, 87%, 6.76, and 0.23, respectively. CONCLUSION: RT-PCR for MTBC proves to be useful in arriving at a conclusive diagnosis in patients with a cytological diagnosis of RLH.

Assessment of Clinically Suspected Tubercular Lymphadenopathy by Real-Time PCR Compared to Non-Molecular Methods on Lymph Node Aspirates.

BACKGROUND: The diagnosis of tubercular lymphadenitis (TBLN) is challenging. This study assesses the role of diagnostic intervention with real-time PCR in clinically suspected tubercular lymphadenopathy in relation to cytology and microbiological methods. METHODS: The cross-sectional study involved 214 patients, and PCR, cytology, and Ziehl-Neelsen (ZN) staining was performed on aspirates. The findings were compared with culture on Lowenstein-Jensen medium. The overall concordance of cytology and PCR, both individually and combined, was calculated. χ2 and Phi values were assessed between cytology, PCR, and culture. RESULTS: A cytological diagnosis of tuberculosis (TB), reactive lymphoid hyperplasia, and suppurative lymphadenitis was made in 71, 112, and 6 patients, respectively. PCR and culture were positive in 40% of the cases. Among the TBLN patients, PCR showed higher positivity in necrosis and culture showed higher positivity in necrotizing granuloma. Positive ZN staining was observed in 29.6% of the TBLN cases, with an overall positivity of 11%. PCR could additionally detect 82 cases missed by ZN staining. The overall concordance rate for either diagnostic modality, i.e., PCR or cytology, was highest (75%), and for PCR alone was 74%. Phi values were observed to be 0.47 between PCR and culture. CONCLUSION: Real-time PCR for Mycobacterium tuberculosis complex on aspirates offers a definitive and comparable diagnosis of TBLN. Including this approach as the primary investigation in the work-up of TBLN could reduce the burden of TB.

Diagnosis of clinically suspected and unsuspected tubercular lymphadenopathy by cytology, culture, and smear microscopy.

BACKGROUND: Tubercular lymphadenopathy (TBLN) accounts for 20-40% cases of extrapulmonary tuberculosis. But the common presenting symptoms of tuberculosis like fever, cough, weight loss, fatigue, and night sweats are not always associated with tuberculosis lymphadenopathy, thereby, making its diagnosis difficult. Our aim was to study if Fine Needle Aspiration Cytology (FNAC) combined with Zeihl Neelsen stain and culture for Mycobacterium tuberculosis bacilli could improve the diagnostic accuracy in patients clinically suspected and unsuspected for tubercular lymphadenitis. METHODS: The study was conducted at Department of Pathology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru medical College, Wardha, India. One hundred and twenty-nine patients with enlarged lymph node for more than two weeks duration were evaluated. All the patients were subjected to cytology, smear, and culture examination of their lymph node aspirate. RESULTS: Age range for the patients was from 1 to 74 years (mean 30.49±16.69) and F:M ratio was 1:1.18. Most common site of involvement was cervical lymph node. 48 patients were diagnosed as TBLN, out of which 19 patients had no associated symptoms and 28 patients had one or more presenting symptoms of tuberculosis. Fever was the most common presenting symptoms. Pediatric age group patients were more commonly associated with symptoms than adults (p value=0.000). Culture and ZN stain were positive in 32 and 10 cases respectively among TBLN. Additionally, culture was positive in 20 patients diagnosed as reactive lymphoid hyperplasia. CONCLUSION: Cytology combined with culture improves the diagnostic accuracy in cases with enlarged lymph nodes, suspected or unsuspected for tuberculosis.

Clinical and cytological features in diagnosis of peripheral tubercular lymphadenitis - A hospital-based study from central India.

BACKGROUND: Tuberculosis lymphadenitis is difficult to diagnose clinically, and often the laboratory confirmation is not available in resource-poor countries. We describe here the symptoms, clinical characteristics, and results of cytological analysis in peripheral tuberculous lymphadenitis patients. METHODS: One hundred and fifty-six patients with peripheral lymph node for cytological evaluation presenting to Department of Pathology, Acharya Vinoba Bhave Rural Hospital, Wardha, India were included in this study. RESULTS: Sixty-nine cases were tuberculous lymphadenitis, with female to male ratio of 1.3:1. One or more constitutional symptoms were present in 59.4% of patients, with 89.9% of lymph nodes ≥2×2cm and the most common site of involvement was cervical lymph node (70.3%). The lymph nodes were multiple (85.5%), either discrete or matted. Cytomorphologically, hemorrhagic aspirate was observed in 29 cases, well-formed epithelioid cell granuloma with caseous necrosis was seen in 34 cases, and Zeihl Neelsen staining was positive in 45 cases. Correlation between character of aspirate and cytomorphological pattern was found highly significant. CONCLUSION: These data suggest that constitutional symptoms and clinical and cytological features help in diagnosing cases of peripheral tubercular lymphadenitis and also open new frontiers to further research that affects the cytological features of these cases.

Molecular Diagnosis of Tubercular Lymphadenopathy from Fine-Needle Aspirates in Pediatric Patients.

OBJECTIVES: The diagnosis of peripheral tubercular lymphadenopathy (TBLN) in pediatric patients is often a challenge because features evident on fine-needle aspiration cytology (FNAC) or tissue biopsy can be deceptive for the reason that they result from an immunological response. This study aimed to evaluate polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex (MTBC) in pediatric patients under clinical suspicion for TBLN and to assess its role in the evaluation of cases cytodiagnosed as reactive lymphoid hyperplasia. METHODS: This was a cross-sectional study conducted on 45 pediatric patients clinically suspected and unsuspected for TBLN. FNAC, culture on Löwenstein-Jensen medium, and real-time PCR were performed. Comparative values with reference to the culture were calculated. RESULTS: Cytology had a sensitivity and specificity of 38.5 and 87.5%, respectively. Real-time PCR had a sensitivity and specificity of 84.6 and 81.3%, respectively. Of the 32 cases with a cytodiagnosis of reactive lymphoid hyperplasia, 53% were positive both on PCR and culture for M. tuberculosis; the φ value of 0.93 demonstrated a strong association between these 2 methods. CONCLUSION: Real-time PCR is useful in detecting MTBC in pediatric patients, and it also helps in the diagnosis of cases missed on FNAC.

Tuberculosis of parotid gland: a rare clinical entity.

Tuberculosis (TB) can affect almost any organ of the body; however, TB of the salivary glands is a rare condition. The purpose of this paper was to report a case of a 14-year-old boy who presented with a painless swelling and discharging sinus in the parotid gland and cervical region on the left side. There was no clinical evidence of systemic signs and symptoms of active TB elsewhere in the body. The combination of clinical suspicion, a positive family history, and the cytological findings confirmed the diagnosis. The patient was successfully treated via antitubercular therapy for six months. This case report suggests that, although primary TB of the parotid gland is an unusual clinical presentation, it should be considered in the differential diagnosis of patients presenting with a parotid gland swelling.

Prevalence of oral mucosal disorders in institutionalized and non-institutionalized psychiatric patients: a study from AVBR Hospital in central India.

Dental treatment is reported to be the greatest unattended health need of people with a disability. The aim of the present study was therefore to quantify the prevalence of oral diseases with a psychosomatic component (recurrent aphthous stomatitis, burning mouth syndrome, and oral lichen planus) in psychiatric patients and to screen these patients for any other oral disorders, so that better care could be provided. In this cross-sectional, single-assessment study, 150 psychiatric patients were evaluated for presence of oral disorders. They were screened based on their socio-demographic profiles, clinical profile, and standardized psychiatric scales. The prevalence of recurrent aphthous stomatitis (RAS), burning mouth syndrome (BMS), and oral lichen planus (OLP) was 19.33%(29 patients), 20.66% (31 patients) and 5.33% (8 patients), respectively, amongst all psychiatric patients. The prevalence of burning mouth syndrome was much higher in patients taking psychiatric medications (25%) than in drug-naïve patients. On screening for other oral disorders, 35.33% of psychiatric patients had at least one other such disorder. We concluded that this patient group experiences a considerable burden of occult oral disorders necessitating thorough oral care. We also described the possible causes of the higher prevalence of oral disorders in psychiatric patients.

Malignant hemangioendothelioma of occipital bone.

Epithelioidhemangioendothelioma is a rare vascular tumor of bone, and rarely these lesions can present as unique and extremely aggressive tumor. We report a case of highly aggressive epithelioidhemangioendothelioma and discuss the imaging findings. CT brain plain study revealed a poorly-defined, mixed density expansile and lytic lesion involving the occipital bone with extension to the left side with poorly defined trabecula formation. There was significant but irregular enhancement after intravenous administration of contrast material and also marked bone destruction. Microscopic examination of the fine needle aspiration cytology showed a tumor composed of vascular channels lined by plump endothelial cells, which had enlarged hyperchromatic nuclei. In view of the extensive infiltration the patient was submitted for the radiotherapy.