Role of Pap Smear Cervical Cytology in the Diagnosis of Extrauterine Malignancies: Largest Study of 104 Cases from Tertiary Care Cancer Centre in India.

INTRODUCTION: Extrauterine malignancies in cervical samples are rarely seen. It is important to differentiate these cells from those of primary uterine malignancies to determine appropriate line of further investigations and management. Literature on these lesions is limited largely restricted to case reports. The aim of the present study was to study the spectrum and cytomorphological features of extrauterine malignancies in cervical Pap smears. MATERIALS AND METHODS: It is a retrospective and descriptive study conducted in Department of Cytopathology from January 2019 to July 2023. All cases of extrauterine malignancies with available cytology material were included in this study. All cases of primary uterine malignancies, i.e., uterine corpus or cervix confirmed by clinical, radiological, and histopathological examination were excluded. RESULTS: 104 out of 11,674 cytology Pap smears were those of extrauterine malignancy. Diagnosis of extrauterine malignancy was given in 47.1% cases, 30.9% were reported as positive for malignancy without giving the possibility of an extrauterine origin, and 22.0% were reported as atypical glandular cells only. In 56 cases where Pap smear was the first investigation which led to the diagnosis. Most common extrauterine malignancy was adenocarcinoma principally from ovarian, colorectal, and vaginal origin. Other epithelial malignancies noted were urothelial carcinoma and invasive breast carcinoma. Among non-epithelial malignancies, we reported vaginal mucosal melanoma, cutaneous melanoma, acute leukaemia, and anaplastic large cell lymphoma. CONCLUSION: High index of suspicion, presence of squamous and glandular elements with no atypical features, and occasional clusters of cells with marked atypia and usually no necrosis in the background are helpful cytomorphological clues to raise suspicion for extrauterine malignancy. Correlation with serology, radiology, and immunocytochemistry can help in reaching final diagnosis.

Cytologic Parameters in Predicting the Outcome of Atypical Glandular Cells on Papanicolaou Smears: A Single-Institutional Experience.

Background: Atypical glandular cells (AGCs) diagnosis on Pap (Papanicolaou) smears are uncommon and may represent various benign and malignant lesions. Objective: This study aims to report the incidence of AGC on Pap smear, to study the relationship of AGC with malignancy, and to determine cytomorphological features that help in predicting malignancy. Materials and Methods: Retrospective analytical study conducted in the Department of Oncopathology at Tertiary Cancer and Research Institute. In this retrospective study, we included cases diagnosed with AGC between July 2017 to July 2022. All slides were reviewed and subclassified according to the Bethesda 2014 classification system (TBS). The predetermined cytomorphological features observed in the smears were recorded. The follow-up histopathological diagnoses of the cases were retrieved. The significant cytomorphological and clinicopathological findings for malignancy were determined. Results: Pearson χ2 test with SPSS software version 22 to compare cytologic features of cases with benign and malignant follow-up. The significant cytomorphological features observed in neoplastic cases were cells in 3-dimensional clusters, nuclear overlapping, reniform nucleus, irregular nuclear membrane, increased nuclear size, single macronucleoli, engulfed neutrophils, and prominently vacuolated cytoplasm. Conclusions: The diagnosis of AGC on cytology is associated with clinically significant lesions, and cytomorphologic parameters can be used to predict the benign and malignant outcome.

Role of FNAC in Extramammary Tumors Metastatic to the Breast.

BACKGROUND: Metastasis to the breast of an extra-mammary origin is very rare. FNAC plays an important role in differentiating non-mammary breast metastasis from primary malignancy. This study aimed to analyze the cytomorphological criteria and its pitfalls in differentiating metastatic lesion of the breast from primary malignancy. METHODOLOGY: Retrospective analysis of 891 FNACs of the breast was performed for a time span of 3 years. A total of 12 cases were diagnosed on FNAC as secondary neoplasms to the breast. Clinical and radiological data, along with Pap and MGG stained smears of each case were examined and correlated with the histopathology of the primary tumor. Statistical analysis was carried out. All cases of primary breast malignancies were excluded from our study. RESULTS: In 10 out of 12 cases, primary malignancies were identified as Plasma cell myeloma (one case), B-acute lymphoblastic leukemia (two cases), acute myeloid leukemia (one case); chronic myeloid leukemia (one case), Burkitt's lymphoma of the ovary (one case), Diffuse large B-cell lymphoma (one case), esophageal squamous cell carcinoma (one case), spindle cell sarcoma (one case) and squamous cell carcinoma of the cervix (one case). The remaining two cases in our study were misdiagnosed on cytology as metastasis and turned out to be breast primaries on histopathology. CONCLUSION: Our case series highlights the importance of FNAC to differentiate secondary lesions from primary breast malignancy and thus helps to avoid unnecessary surgery to the patient. It emphasizes on the need to keep in mind the possibility of metastatic breast neoplasms in the presence of unusual cytological features on FNAC.

The value of cytology in diagnosis of serous effusions in malignant lymphomas: An experience of a tertiary care center.

BACKGROUND: Malignant lymphomas (ML) are often complicated by serous effusions. The present study is an attempt to cytologically assess a large series of serous effusions associated with ML, identify the immunoreactivity of cells and to evaluate the role of various ancillary methods in confirming and subtyping these cases. METHODS: A cross-sectional study of 4612 serous effusions was undertaken at the Department of Cytology, Gujarat Cancer and Research Institute by retrieving data from the year 2015 to 2017. Total 169 cases of ML, clinically suspicious, were included. All cerebrospinal fluids, serous effusions involved by myeloid neoplasms, and cases of primary effusion lymphomas were excluded from our study. Pap stained smears of all these serous effusions were examined. Ancillary methods such as immunohistochemistry were used to further subtype the positive cases using the WHO classification of hematopoietic and lymphoid neoplasms (2016). RESULTS: Out of total 169 clinically suspicious cases, 109 cases were cytologically positive for ML which included 73 (66.9%) pleural effusions, 34 (31.1%) ascitic fluids, and 2 (1.8%) pericardial effusions. T-lymphoblastic lymphoma (36.9%) and Burkitt's lymphoma (38.2%) were the most common ML involving the pleural and ascitic fluids respectively. Non-Hodgkin's lymphoma (NHL) more frequently involved the serous cavities than Hodgkin's lymphoma. (P value <.0001). Among the NHL, T-cell lymphomas more commonly lead to serous effusions than B-cell lymphomas (P value <.0048). CONCLUSION: Cytological examination of serous effusions is an accurate, prompt, affordable technique having diagnostic and therapeutic implications. With the help of ancillary methods, we can identify the phenotype of cells, classify as well as confirm our diagnosis.

Metastasis of soft tissue sarcomas in lymph node: A cytomorphological study.

BACKGROUND: Soft-tissue sarcoma (STS) rarely metastasizes to lymph node compared to carcinoma. Fine-needle aspiration cytology (FNAC) carries a pivotal role in diagnosis of metastatic tumor to lymph node. This study highlights the role of FNAC in diagnosis of STS metastasis to lymph node. METHOD: A retrospective study over a period by 4 years carried out. FNAC of enlarged lymph node was performed in patients with STS. Cytology smears were examined in conjunction with clinical details. Histopathology and Immunohistochemistry (IHC) were correlated in synchronous cases. RESULTS: Out of 326 patients, 21 with STS had enlarged lymph nodes, of which 19 cases showed involvement (5.8%). Sixteen cases were metachronous and 3 cases showed synchronous involvement. Fifteen cases had regional lymph nodes while 4 cases had distal lymph node involvement. Head and neck and lower extremities were the most common primary sites of STS. Rhabdomyosarcoma was the most common sarcoma metastasing to the lymph nodes followed by synovial sarcoma, malignant peripheral nerve sheath tumor, and clear cell sarcoma. Other rare tumors included leiomyosarcoma, epitheloid sarcoma, liposarcoma, malignant fibrous histiocytoma, and Ewing's sarcoma/peripheral neuroectodermal tumor. We had a case of dermatofibrosarcoma protuberance (DFSP) of scalp with cervical lymph node metastasis. Very unusual about this case was its rare primary site and the rarer lymph node metastasis. CONCLUSION: FNAC plays an important role in the diagnosis of lymph node metastasis in cases of STS.

Accuracy of cytology in sub typing non small cell lung carcinomas.

BACKGROUND: Sub typing of non small cell lung carcinoma (NSCLC) has an important task in the era of molecular and targeted therapies. Differentiating between squamous cell carcinoma (SQCC) and adenocarcinoma (ADC) is challenging when limited material is available in lung carcinoma. We investigated the accuracy and feasibility of sub typing NSCLCs in cytology and small biopsy material. METHODS: Concurrent cytology and biopsy material obtained in a single CT- guided procedure in lung carcinoma over a year period retrospectively. Both materials were individually sub typed and analyzed. Immunohistochemistry (IHC) was performed. Accuracy was determined by comparing the results with IHC. RESULTS: Total 107 of 126 cases of NSCLCs were included for analysis, where both cytology and biopsy material were adequate for interpretation. FNAC allowed tumor typing in 83 (77.6%) cases; 36 (33.6%) were ADC, 47 (43.9%) cases were SQCC and 24 (22.4%) cases diagnosed as Non-small cell carcinoma not otherwise specified (NSCLC-NOS). In biopsy, 86 cases (80.4%) were typed, among which 34 (31.8%) were ADC, 52 (48.6%) were SQCC and 21 (19.6%) were of NSCLC-NOS type. The result of Chi-square index was significant. With the aid of IHC, NSCLC-NOS reduced from 14 (13%) cases to 2 (1.9%) cases. CONCLUSION: Cytology and small biopsy specimens achieved comparable specificity and accuracy in sub-typing NSCLC and optimal results were obtain when findings from both modalities combine. The advantage of paired specimens is to maximize overall diagnostic yield and the remaining material will be available for ancillary technique like IHC or for molecular testing. Diagn. Cytopathol. 2017;45:598-603. © 2017 Wiley Periodicals, Inc.

Primary hepatic lymphoma: A case report.

Primary non-Hodgkin lymphoma of the liver is a very rare malignancy. In this case report, we describe a case of primary hepatic lymphoma (PHL) in a 60-year-old man who presented with lump and pain in the abdomen of 2 months' duration. The patient had altered liver function, normal serum alfa fetoprotein level (AFP), normal hemogram and bone marrow. A computed tomography scan of the abdomen and pelvis showed an ill-defined hypodense mass with specks of calcification involving the liver, suggestive of primary malignant mass of liver. Diagnosis of PHL was established on the cytology smear and confirmed by immunohistochemistry on tissue biopsy. This case demonstrates that PHL should be considered in the differential diagnosis of space-occupying liver lesions in the presence of a normal level of AFP. Fine needle aspiration cytology is a faster and safer diagnostic modality even in such a rare case. The case has many unique features like negative serology for viruses, no type B symptom and normal lactate dehydrogenase level.

Axillary node metastasis from primary ovarian carcinoma.

Metastasization and distinction from mammary carcinoma is of great clinical importance because of different treatment modalities. Here, we discuss a case of stage IIIC ovarian serous carcinoma, presenting with bilateral axillary nodes metastasis after 25 months interval of its initial presentation. Increased serum CA-125 level caused clinical suspicion. Computed tomography scan of abdomen and pelvis showed no residual disease or any abdominal lymphadenopathy. Mammography of both breast were normal. Bilateral axillary nodes were noted. Guided fine needle aspiration cytology (FNAC) and biopsy of ovarian carcinoma to axillary node is a rare event. Its recogn done. Cytomorphology revealed poorly differentiated carcinoma, compatible to that of primary ovarian tumor. Thus, metastatic carcinoma to axillary node from ovary was confirmed. This case illustrates a rare metastatic presentation of ovarian carcinoma and unequivocal role of FNAC to provide rapid diagnosis and preferred to be first line diagnostic procedure.