A Comparative Study of Fine-Needle Aspiration and Nonaspiration Cytology Diagnosis in Thyroid Lesions.

BACKGROUND: Aspiration cytology is one of the first-line diagnostic tests in thyroid malignancies. Fine-needle aspiration cytology (FNAC) in thyroid lesions causes hemorrhagic smear and cell trauma, often leading to the repetition of smear and delay in diagnosis. This study was conducted to identify the diagnostically superior technique with regard to thyroid swelling and to assess the quality of smears obtained from FNAC and fine-needle nonaspiration cytology (FNNAC). METHODOLOGY: This was a prospective diagnostic study carried out for 2 years in a tertiary care center from South India. All patients with complaints of thyroid swellings, after examination, underwent FNNAC, followed by FNAC of the lesion. They underwent thyroidectomy when indicated. The final postoperative biopsy reports were compared with the preoperative reports of these two techniques (FNNAC and FNAC). The quality of smears was compared using Mair's score. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in diagnosing malignancy were 93.4%, 100%, 100%, 98.78%, and 98.96% for FNNAC and 94.12%, 100%, 100%, 98.82%, and 99% for FNAC, respectively, which were comparable. Regarding the quality of smears, FNNAC had more smears with less blood in the background. FNAC had more smears with adequate cellularity. The difference in overall Mair's score between the two techniques was not significant (P = 0.28). CONCLUSION: No difference was found in the accuracy of FNAC and FNNAC in diagnosing thyroid lesions. Furthermore, the smear quality of both techniques was comparable. Hence, either can be used based on the operator's preference and experience.

Role of brush cytology in the diagnosis of neoplastic and non-neoplastic upper gastrointestinal lesions.

OBJECTIVE: To evaluate the utility of brush cytology (BC) in diagnosing non-neoplastic and neoplastic lesions of the upper gastrointestinal (GI) tract. METHODS: The study comprised 106 brushings from 104 patients with clinically suspected lesions in the upper GI tract. Diagnoses were rendered on correlating brush cytological findings with clinicoradiological findings and compared with endoscopic biopsies (EB). An attempt was made to grade oesophageal squamous cell carcinomas (SCC) and to subcategorise gastric adenocarcinomas (AC). The sensitivity, specificity and predictive values of BC were calculated with respect to clinico-radiological outcome. RESULTS: Malignant and benign lesions on BC comprised 74.5% and 25.5%, respectively, and on histology, 64.2% and 28.3%, respectively. Twenty-one of 32 (65.6%) gastric ACs were accurately sub-typed (16 intestinal and five diffuse) and 25/36 (69.4%) oesophageal SCCs (7, 15 and three well, moderately and poorly differentiated, respectively) were accurately graded. On correlation with the final clinico-radiological diagnosis, there was one false-positive and no false-negative cases, respectively, on BC; three false-negative and no false-positive cases, respectively, on EB; eight EB were non-representative in which a diagnosis was not rendered, out of which seven were malignant. Thus, BC had a sensitivity and specificity of 100% and 96.4%, respectively, with a positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of 98.7%, 100% and 99.1% (P ˂ 0.05), respectively. BC was superior to EB in detecting Candida species and EB in detecting Helicobacter pylori. CONCLUSIONS: BC is a useful, routinely applicable and reliable test for diagnosing upper GI lesions.

A systematic approach to assess the strengths and limitations of cytomorphology in the diagnosis of the follicular variant of papillary thyroid carcinoma.

OBJECTIVE: To identify the most useful cytomorphological features of follicular variant of papillary thyroid carcinoma (FVPTC). METHODS: Fine needle aspiration cytological features of seven histologically proven FVPTCs were systematically evaluated in a blinded manner for various architectural, nuclear, cytoplasmic and background features with special reference to nuclear morphology. RESULTS: Most smears were moderate to highly cellular with clustered and/or repetitive microfollicles, rare macrofollicles and minimal thick gummy colloid. Six of seven cases showed significant nuclear crowding/overlapping. Fairly uniform nucleomegaly (mostly three to five times the size of a mature lymphocyte) of intact neoplastic cells and enlarged naked nuclei were prominent features in all seven cases, whereas enlarged ovoid nuclei were seen in two cases. Chromatin was fine to coarsely granular and evenly distributed. Occasional nuclear grooves (NGs) and intranuclear cytoplasmic inclusions (INCIs) were seen in five and three cases, respectively. This refined approach led to a precise diagnosis of FVPTC in six cases, which were earlier interpreted as various follicular lesions. Follicular hyperplasia was excluded by the absence of significant amounts of colloid and atretic naked nuclei, whilst the possibility of follicular adenoma or follicular carcinoma was excluded by the presence of one or more features suggestive of papillary thyroid carcinoma. CONCLUSIONS: Our study showed a high cell yield, microfollicular pattern, nuclear overcrowding/overlapping, scanty gummy colloid and enlarged naked nuclei as the most consistent features of FVPTC. Although inconsistent, features such as enlarged ovoid nuclei and syncytial clusters were complementary to the diagnosis in the absence of NGs and INCIs.

Effect of Butea monosperma Lam. leaves and bark extracts on blood glucose in streptozotocin-induced severely diabetic rats.

BACKGROUND: Diabetes mellitus is a chronic metabolic disorder that has significant impact on the health, quality of life and life expectancy, as well as on the health care system. Butea monosperma Lam. Kuntze (Fabaceae), commonly known as palash, is widely used in the treatment of various diseases and disorders including diabetes. MATERIALS AND METHODS: The present study was planned to evaluate the antidiabetic effect of aqueous extracts of B. monosperma leaves and bark in streptozotocin-induced severely diabetic rats. The animals were divided into four groups, with each consisting of six rats, viz. control, diabetic control, leaf extract-treated and bark extract-treated groups. Treatment was continued for 6 weeks. The biochemical estimations included blood glucose and serum insulin levels. Histopathology of pancreas was also performed. RESULTS: The results indicated that both leaf and bark extracts of B. monosperma produced insignificant antihyperglycemic activity. The leaf and bark extracts reduced blood glucose to an extent of 28% and 11%, respectively. It was also evidenced that both leaf and bark extracts did not increase insulin synthesis or secretion and did not improve pancreatic architecture as reflected by the histopathologic studies. CONCLUSIONS: The findings of the study emphasize that B. monosperma does not possess significant antidiabetic activity in severe experimental diabetes at the dosage tested.

Significance of eosinophils in diagnosing Hashimoto's thyroiditis on fine-needle aspiration cytology.

BACKGROUND: Hashimoto's thyroiditis (HT) is the most common cause of hypothyroidism in those areas of the world where iodine levels are sufficient. Fine-needle aspiration cytology (FNAC) can accurately diagnose this lesion in most of the patients. However, a small percentage of cases may be missed due to inherent limitations of this procedure. Therefore, cytologic clues to increase sensitivity of diagnosis need to be searched for. AIMS: To assess whether an eosinophilic infiltration of the thyroid gland has a higher association with HT than colloid goiter. MATERIALS AND METHODS: The study was a case-control study. Smears obtained by FNAC of 50 case, each of HT (which served as cases) and colloid goiter (which served as controls) were observed. The number of eosinophils and neutrophils per high-power field (HPF) was counted in all the smears. The eosinophil-neutrophil ratio in the smears, diagnosed as HT, was then compared with that of colloid goiter using unpaired t-test. RESULTS: Smears diagnosed as HT was found to have a significantly higher eosinophil-neutrophil ratio than smears diagnosed as colloid goiter (P value 0.0001). CONCLUSION: Eosinophilic infiltration of the thyroid gland has higher association with Hashimoto thyroiditis.

Pseudoglandular pattern of basaloid cells in pilomatrixoma in the needle aspiration cytology: a case report.

A varied cytomorphology of pilomatrixoma often results in diagnostic dilemma. Here, we report a case of pilomatrixoma that presented with prominent gland like arrangement of basaloid cells on cytologic smears causing diagnostic problem. Clinical diagnosis in the present case was cervical lymphadenitis and the cytologic smears showed a strikingly varied morphology with few loose clusters of basaloid cells exhibiting pseudoglandular pattern. A possibility of metastatic carcinoma was considered. However, following histopathologic diagnosis of pilomatrixoma, when cytologic smears were reviewed, it was realized that the ghost cells were overlooked as anucleate squames. Our case highlights the importance of careful clinical and cytologic interpretation of pilomatrixoma. Awareness of the cytomorphologic characteristics of ghost cells and their identification in cytologic smears is highly criticalfor an accurate diagnosis. A prominent basaloid cell component of pilomatrixoma with a pseudoglandular pattern, which has not been described earlier, may easily lead to a false positive diagnosis.

Leprous osteitis presenting as bone cyst and erosions.

A 30-year-old man presented to the Hansen outpatient department with swelling and ulceration of toes for 2 months and swelling of the right fifth and fourth fingers and the left second finger for 1 month. In addition to skin lesions of lepromatous leprosy (subpolar type), there was nontender, non-fluctuant swelling of the right fifth and fourth fingers and left second finger. Skin over the right fifth finger showed sinus-like openings with associated purulent discharge. He also had swelling and ulceration of second left toe. Slit-skin smear (SSS) showed a bacterial index of 6+ from the ear lobes and cutaneous nodules, 4+ from the patch, and 3+ from normal skin. Modified Ziehl-Neelsen staining of the discharge extruding from the sinuses on the right fifth finger also showed abundant acid-fast bacilli. Radiography of the hands and feet showed lytic lesions in the distal epimetaphyseal region o proximal phalanx of the right fifth finger and left second finger and erosion of distal end of proximal phalanges of both second toes. Histopathological examination of biopsy specimen from the patch (back) showed features of lepromatous leprosy, and Fite-Faraco stain for tissue acid-fast bacteria (AFB) was strongly positive. Fine-needle-aspiration cytology (FNAC) from the lytic lesion in the bone also showed predominantly foamy macrophages with strongly positive staining for AFB with a few interspersed lymphocytes, epithelioid cells and Langhans giant cells. On the basis of these features, a clinical diagnosis of subpolar lepromatous leprosy with leprous osteitis was made. In today's clinical era of improved case detection and prompt treatment with effective multidrug regimens, advanced bone changes are rarely encountered. We describe this case of lepromatous leprosy that developed cavitating lesions of the phalanges of the hand, seen on x-ray as well-defined bone cyst and erosions.

Chronic myeloid leukemia presenting with avascular necrosis of femur head.

We report the case of a 15 years girl in whom avascular necrosis (AVN) of right femur head was the presenting feature of chronic stable phase of chronic myeloid leukemia (CML). To date, only three case of CML with AVN have been reported. So, in view of rarity of this condition, a similar case of CML presenting as AVN of femur head is being reported.