Diagnosis of erythema nodosum leprosum (type 2 reaction) by cytology.

OBJECTIVE: It was the aim of this study to evaluate the possible role of cytology in erythema nodosum leprosum (ENL) and its use for early treatment of the disease. STUDY DESIGN: We present a prospective study conducted with 15 clinically diagnosed ENL cases. Among them, 13 cases had previously been diagnosed with lepromatous leprosy (LL) and 2 patients were new LL cases with signs and symptoms of ENL lesions. Haematoxylin and eosin stain with modified Ziehl-Neelsen stain was performed on fine needle aspiration material. One case was sent for biopsy. RESULTS: Complete cytological diagnosis of ENL was done in all 15 cases. Histopathological study revealed classical ENL lesions which also showed ENL features in cytodiagnosis. CONCLUSION: In the past, the accurate mode of diagnosis of ENL lesions was histopathology. However, clinicians have to wait a long time for the report and generally they start treatment only on the basis of clinical signs and symptoms. Cytodiagnosis of ENL lesions is an early, effective method for accurate diagnosis and helps to initiate treatment for these painful lesions.

Clinico-Pathological Study of Cutaneous Granulomatous Lesions- a 5 yr Experience in a Tertiary Care Hospital in India.

BACKGROUND: Granulomatous dermatoses are common skin pathology, often need histopathological confirmation for diagnosis. Histologically six sub-types of granulomas found in granulomatous skin diseases- tuberculoid, sarcoidal, necrobiotic, suppurative, foreign body & histoid type. The aims of the present study were clinico-pathological evaluation of granulomatous skin lesions and their etiological classification based on histopathological examination. METHODS: It was a five years (Jan 2009- Dec 2013) retrospective study involving all the skin biopsies. Detailed clinical and histopathological features were analyzed and granulomatous skin lesions were categorized according to type of granuloma & etiology. Special stains were used in few cases for diagnostic purpose. RESULTS: Among 1280 skin biopsies, 186 cases (14.53%) were granulomatous skin lesions with a ratio 1:24. In histopathological sub-typing, tuberculoid granuloma was most common type (126 cases, 67.74%). Most common etiology of granuloma in the study was leprosy (107 cases, 57.52%). Other etiologies were cutaneous tuberculosis, foreign body granulomas, fungal lesions, cutaneous leishmaniasis, sarcoidosis and granuloma annulare. CONCLUSION: Histopathology is established as gold standard investigation for diagnosis, categorization and clinico-pathological correlation of granulomatous skin lesions.

Cytological Study of Breast Carcinoma Before and After Oncotherapy with Special Reference to Morphometry and Proliferative Activity.

Our study was done to assess the cytological changes due to oncotherapy in breast carcinoma especially on morphometry and proliferative activity. Cytological aspirates were collected from a total of 32 cases of invasive ductal carcinoma both before and after oncotherapy. Morphometry was done on the stained cytological smears to assess the different morphological parameters of cell dimension by using the ocular morphometer and the software AutoCAD 2007. Staining was done with Ki-67 and proliferating cell nuclear antigen (PCNA) as proliferative markers. Different morphological parameters were compared before and after oncotherapy by unpaired Student's t test. Statistically significant differences were found in morphometric parameters, e.g., mean nuclear diameter, mean nuclear area, mean cell diameter, and mean cell area, and in the expression of proliferative markers (Ki-67 and PCNA). Statistical analysis was done by obtaining p values. There are statistically significant differences between morphological parameter of breast carcinoma cells before and after oncotherapy.

Elephantine Psoriasis with Papillomatosis and Alternating Hypogranulosis and Hypergranulosis.

Psoriasis is a disease of considerable clinical and histopathological diversity. We report a rare case of elephantine psoriasis responding very well to methotrexate. Histopathology revealed abnormal papillomatosis with finger-like projections in addition to alternating orthokeratosis with overlying hypergranulosis and parakeratosis with overlying hypogranulosis. We believe that this finding may represent an odd histopathologic type in elephantine psoriasis.

Cytological and morphometric study of urinary epithelial cells with histopathological correlation.

This study has been done to asses the utility and accuracy of urinary cytology and morphometric study of exfoliated cells in early detection and follow-up of urothelial neoplasms and thereby help to reduce the disease-related mortality and morbidity. A total 100 patients with urinary symptoms were studied by cytological examination of urine along with morphometric analysis of suspicious epithelial cells. Immunostaining to detect CK-20 expression and p53 over expression was done in smears showing atypical cells. Histopathological confirmation was done in cases which were suspicious on cystoscopy. P value was determined by using unpaired t-test. Statistically significant difference was found between neoplastic and non-neoplastic lesions of the urinary bladder as far as morphometry is concerned. Urinary cytology along with morphometry is an important tool in early detection of urothelial neoplasms. It is also helpful to find out the recurrences during post-operative follow-up period. Overexpression of CK-20 and p53 immunostain in cytology can act as an adjunct to the cytological diagnosis.

Study of lymph node lesions with fine needle aspiration cytology and histopathology along with immunohistochemistry.

Lymphadenopathy is one of the commonest clinical presentations of the patients attending hospital outdoor. Aetiology varies from Inflammatory process to malignant conditions. Fine needle aspiration cytology has become an integral part of the initial diagnosis. Histology remains the gold standard. But there exists some gray zones both in cytology and histology where immunohistochemistry plays a major role for final diagnosis. In this study, an attempt has been made to evaluate the importance of immunohistochemistry in this field. Fifty cases were studied. Clinical history was noted and examination done. All cases were examined both cytologically and histologically. Immunocytochemistry was done in all the cases by monoclonal antibody against p53 and Ki67. The results were tabulated and analysed according to unpaired 't' test. Reactive hyperplasia was present in maximum number followed by tuberculosis, non-Hodgkin's lymphoma and Hodgkin's lymphoma. All of these lesions showed statistically significant difference in p53 and Ki67 expression both in cytology and in histology. To conclude, fine needle aspiration cytology is an adjuvant to histology for early diagnosis and immunohistochemistry can help us in the gray zones.

Morphometric and histological study of breast lesions with special reference to proliferative activity and invasiveness.

Breast carcinoma is the most common cause of carcinoma death in women. Sometimes, difficulty arises to differentiate between premalignant lesions and carcinoma by routine histopathology. Our study was done to establish the role of morphometry and immunohistochemistry to solve this problem. In this study, total 60 cases of different breast lesions were included and 10 controls were also included to compare the results with the normal findings. They were studied by hematoxylin and eosin-stained sections for morphometry and routine histological study; as well as by proliferative markers such as proliferating cell nuclear antigen and p53. Invasiveness was studied using immunohistochemical staining with 34 ßE12 monoclonal antibody. Statistically significant differences were found in morphometric parameters and in expression of proliferative markers between most of them. Morphometry and immunohistochemistry help in the proper diagnosis of different breast lesions that lie in the gray zone on routine histopathology.

Study of immunohistochemistry in prostatic lesions with special reference to proliferation and invasiveness.

Prostatic lesions on routine staining sometimes cause diagnostic dilemma especially in premalignant lesions like atypical adenomatous hyperplasia and prostatic intraepithelial neoplasia. Benign small acinar lesions also may be difficult to differentiate from small acinar adenocarcinoma. An important differentiating point is the loss of basal cell layer in adenocarcinoma and its presence in benign lesions. Basal cell markers (e.g. 34ßE12 cytokeratin) & proliferative markers (e.g. AgNOR and PCNA) can help in this regard. Total 60 cases of different prostatic lesions studied. After history taking, clinical examination, radiological & other investigations were done. Routine H&E staining, immunohistochemical staining against 34ßE12 cytokeratin & proliferative markers (AgNOR & PCNA) was performed. Statistically significant differences found in expression of 34ßE12 cytokeratin and proliferative markers between benign, premalignant and malignant prostatic lesions. Basal cell markers and proliferative markers are important parameters to distinguish between different benign, premalignant and malignant prostatic lesions.

Role of proliferative markers in breast lesions.

BACKGROUND: Carcinoma of breast is a leading cause of death in women throughout the world. Difficulty in diagnosis occurs in routine Hematoxylin and Eosin (H&E) stained sections to differentiate premalignant lesions like epitheliosis and malignant lesions like carcinoma in situ which may affect prognosis. AIMS: Our study was done to assess the role of proliferative markers in this field. MATERIALS AND METHODS: In this study, total 66 cases of different breast lesions were studied by H&E stained sections as well as proliferative markers like silver staining nucleolar organizer region (AgNOR) and proliferating cell nuclear antigen (PCNA). RESULTS: Statistically significant differences found in expression of proliferative markers between most of them. CONCLUSION: Study of proliferative markers help in the proper diagnosis of different breast lesions which lies in the grey zone on routine histopathology.

Study of salivary gland lesions with fine needle aspiration cytology and histopothology along with immunohistochemistry.

Salivary gland swelling is a common and important problem. Acute and chronic sialadenitis, different benign and malignant neoplasms are the common causes which present with salivary gland swelling. Imaging technique is not so helpful in pre-operative diagnosis; microscopical examination is required for diagnosis. Pre-operative core needle biopsy is hazardous and may damage facial nerve, lead to fistula formation or associated with tumour seeding. Fine needle aspiration cytology (FNAC) is however virtually risk-free. The study was done to assess the utility of FNAC and its accuracy and pitfalls with respect to histopathology and advantages of immunohistochemistry. The study was done with 40 cases of salivary gland swelling. After clinical examination, FNAC and histopathological examination along with immunohistochemistry was done and the results were correlated. Out of 40 cases, 25 involved the parotid gland, most common age group affected was 20 - 40 years and male: female ratio was 5: 3. Out of 40 cases 37 cases were cytologically and histopathologically correlated and rest 3 cases were different. Among these 3 cases, 2 were adenoid cystic carcinoma which was cytologically diagnosed as benign neoplasm (monomorphic adenoma). One case of Warthin's tumour was cytologically diagnosed as pleomorphic adenoma. The sensitivity of this study was found to be 71.43%, specificity 100% and accuracy was 93.10%. This study corroborates well with other studies including immunohistochemical findings. p53 expression was found to be related with nature of the neoplasm. FNAC is an important tool for early diagnosis of salivary gland lesions.

Fine needle aspiration cytology of thyroid gland and histopathological correlation--revisited.

Fine needle aspiration of the thyroid gland, followed by cytological studies and their correlation with histopathological diagnosis have been undertaken to assess the effectiveness of fine needle aspiration cytology in diagnosing disorders of this gland. The cases in which discrepancies had arisen between these two methods of diagnosis have also been reviewed. Out of the total 100 patients studied, 28 were cases of simple colloid goitre, 17 of adenomatoid goitre, 10 of autoimmune thyroiditis ranging from lymphocytic thyroiditis to Hashimoto's thyroiditis, 28 of follicular neoplasia, 10 of papillary carcinoma, one of medullary carcinoma, 2 of anaplastic carcinoma and 4 of cystic lesions of the thyroid gland. Although, fine needle aspiration cytology of the thyroid gland was diagnostic in 75% of cases, it did not correlate with the histopathological diagnosis in the remaining 25% of cases. Possible reasons behind these discrepancies have been discussed.