Tuberculous lymphadenitis: extended cytomorphologic features.

In tuberculous lymphadenitis, FNAC smears sometimes reveal only caseous necrosis without epithelioid cell granuloma. They pose a diagnostic problem, if AFB staining is negative. The diagnostic clue noticed in these cases was presence of multiple pink, homogenous structures with irregular shape and well-defined margins: "eosinophilic structures" (ES). The purpose of the present study is to find out the nature of ES and their role in the diagnosis of tuberculosis. Seventy FNAC smears from documented cases of tuberculous lymphadenitis were classified according to their cytomorphological features. The association and relation of ES with other morphological criteria was noted. Immunoperoxidase staining was performed to find out the reactivity of ES to tuberculous antigen. Its intensity of positivity was compared with epithelioid cell granuloma and degenerating granuloma. It was concluded that ES are degenerated granuloma and thus form an extended diagnostic criterion.

Value of Papanicolaou smear in detection of Chlamydia trachomatis infection.

This study was undertaken to assess the value of Papanicolaou smear for the diagnosis of Chlamydia trachomatis infection. The study was both retrospective (groups I and II) and prospective (group III). Group I consisted of 41 smears with cytomorphological changes proposed by Gupta, Kiviat, or Shiina. Group II was a control group, consisting of 30 cytologically normal smears. All these smears were subjected to specific immunofluorescent (IF) staining under identical conditions to confirm the diagnosis. In group III, 40 consecutive duplicate cervical smears were collected from patients attending the Sexually Transmitted Disease Clinic. One smear was routinely examined, and the specific IF staining was done on the other smear. The results in all the three groups were analysed. It was concluded that Papanicolaou smear is not useful in the detection of Chlamydia trachomatis infection.

Actinomycotic mycetoma. Report of a case with diagnosis by fine needle aspiration.

Mycetoma (madura foot, maduromycosis) is present worldwide but more so in the tropics. We report a case of actinomycetoma diagnosed by fine needle aspiration using cell smears. The authors believe it to be the first case so diagnosed. Definitive diagnosis of the etiologic agent is made by culture, leading to a delay in institution of treatment. The authors advocate the use of fine needle aspiration for rapid diagnosis, thus instigating further workup and treatment.

Filarial infection of the breast. Report of a case with diagnosis by fine needle aspiration cytology.

The breast is not a frequent site of filarial infection. We report a case of fine needle aspiration cytologic diagnosis of filariasis of the breast, not previously reported.

Worrisome histologic alterations following fine needle aspiration of the thyroid.

OBJECTIVE: To investigate worrisome histologic alterations following fine needle aspiration (FNA) of the thyroid (WHAFFT). STUDY DESIGN: Of 1,890 FNA thyroid cases, 265 underwent surgical excision. The histologic sections of these cases were studied for WHAFFT lesions. Thirty control cases were also studied. RESULTS: WHAFFT lesions were present in 38.49% of cases. Acute lesions were seen in 30 and chronic in 72 cases. Control cases did not show WHAFFT lesions. The common lesions were hemorrhage and fibrosis. Worrisome lesions, like nuclear atypia, vascular changes, capsular pseudoinvasion and metaplasia, were present in 32 (12.07%) cases. CONCLUSION: Considering the large number of FNAs and reduction in the number of thyroid excisions, the advantages of FNA are manifold as compared to the few diagnostic problems. Misdiagnosis can be avoided with awareness of WHAFFT lesions.

Cutaneous blastomycosis. Report of a case with diagnosis by fine needle aspiration cytology.

BACKGROUND: Blastomycosis is rare in India. Clinically, cutaneous blastomycosis may be mistaken for keratoacanthoma, squamous cell carcinoma, tuberculosis, tertiary syphilis, leprosy or pyoderma. CASE: A 19-year-old male presented with a soft, fluctuant swelling at the medial canthus of the eye. Fine needle aspiration biopsy (FNAB) showed many single, spherical structures with thick walls. They had basophilic protoplasm and six nuclei in the center. A few of them showed budding with a broad base. CONCLUSION: The cytomorphology of Blastomyces dermatitidis is characteristic, and the organism can be differentiated from other yeast forms. The disease is sensitive to antifungal imidazole derivatives and can be cured.

Cytodiagnosis of metastatic melanoma in the lymph nodes.

Lymph-node aspirates performed over ten years numbering 1,555 showed 8.2 percent of metastatic tumors. Of these, only six percent were metastatic melanomas. Clinical diagnosis was made in three cases. Melanin in the cells made the diagnosis easy. But even in the absence of the pigment as in two amelanotic melanomas, the cytologic features were characteristic.

Differentiation of follicular adenoma and carcinoma of thyroid by immunohistochemical demonstration of ceruloplasmin.

In this study, and attempt was made to differentiate between follicular neoplasms of the thyroid using an immunoperoxidase staining technique for detection of ceruloplasmin. 54 histologically proved benign and malignant thyroidal lesions were selected. The staining for ceruloplasmin was consistently positive in follicular carcinoma and negative in follicular adenoma.

Idiopathic retroperitoneal fibrosis: a report of 3 cases.

Case histories of three male patients diagnosed as idiopathic retroperitoneal fibrosis either on autopsy or following intra-operative biopsy are reported. Two of them were in the 5th decade and one aged 22 yrs. All of them presented with features of urinary tract obstruction and renal failure. The obstruction was detected either by ultrasonography or following ascending pyelogram. One of them underwent peritoneal dialysis but later on died of sudden cardiac arrest. The remaining two underwent surgery, during which a biopsy was taken. Histological examination in all the three patients revealed fibroblastic proliferation and mononuclear cell infiltration. Features of chronic periaortitis were also found in the autopsy specimen of descending aorta of the first patient. Both the elderly patients had aortic atherosclerosis which is suspected to be the etiological factor for fibrosis. However in the young male patient intense eosinophilic infiltrate was observed in biopsy material pointing towards 'hypersensitivity' reaction as a cause for fibrosis.