Dynamic contrast-enhanced magnetic resonance perfusion volumetrics can differentiate tuberculosis of the spine and vertebral malignancy.

BACKGROUND: There is considerable overlap in radiologic features of tubercular and malignant spinal lesions on conventional magnetic resonance imaging (MRI). PURPOSE: To evaluate the role of dynamic contrast-enhanced (DCE) MRI perfusion parameters in differentiating vertebral malignancy from spinal tuberculosis. MATERIAL AND METHODS: This was a prospective study and we enrolled consecutive patients presenting with a clinical/radiologic evidence of vertebral lesions. DCE-MRI of the spine was performed using 3D volume interpolated breath-hold examination (VIBE) sequence after intravenously injecting 0.1 mmol/kg body weight of gadopentetate dimeglumine. We used Tofts model to calculate DCE parameters that included Ktrans (transfer constant), kep (rate constant), ve (fractional volume of extracellular extravascular space), and iAUC (initial area under the curve). We compared the mean value of each perfusion parameter by type of lesion (tubercular/malignant) at 0.05 significance level and performed receiver operating characteristic curve analysis. RESULTS: We could confirm histologic/cytologic diagnosis in 35 of the 45 patients recruited. Of these, 19 were tubercular and 16 were malignant lesions. The mean (± standard deviation) of kep (min-1) was significantly higher (2.89 ± 3.3) in malignant compared to tubercular lesions (0.81 ± 0.19), whereas ve was significantly lower in malignant (0.27 ± 0.13 mL/g) compared to benign lesions (0.47 ± 0.12 mL/g) at 0.05 significance level. kep cutoff of ≥1.17 min-1 had a sensitivity of 93.8% and specificity of 100% with a diagnostic accuracy of 94.4% in detecting malignant disease. CONCLUSION: High kep is the single best predictor of malignant vertebral lesions. We recommend kep cutoff value of ≥1.17 min-1 that has high diagnostic accuracy in identifying malignant lesions.

Diagnostic accuracy of fine needle aspiration cytology of bone lesions: A study of Tertiary Care Institute.

AIMS AND OBJECTIVES: The aim is to study the spectrum and cytomorphological features of bone lesions and find out the diagnostic accuracy of Fine needle aspiration cytology (FNAC) on the same. MATERIALS AND METHODS: The study was a cross-sectional study conducted in the Department of Pathology and Orthopedics in a tertiary institute in north India over a period of 1 year in 55 patients. All the patients were subjected to FNAC of bone lesions followed by tru-cut or open bone biopsy. Cytosmears were stained with May Grunwald Giemsa and Hematoxylin and Eosin were done on biopsy specimens. Sensitivity and specificity were calculated in percentage with a 95% confidence interval with reference to biopsy specimens. RESULTS: Two peaks were observed; one between 11 and 40 years with 32 cases and another at 51 and 60 years with 12 cases. The male to female ratio was 1.4:1. In the present study, inflammatory lesions were present in 17 (31%) cases, 2 were tumor-like conditions; 10 (18%) cases of primary benign tumors, 26 (47.2%) cases were malignant. Out of these, 15 (27.2%) were primary malignant bone tumors and 11 (20%) were secondary in nature. The sensitivity, specificity, and diagnostic accuracy of the FNA of bone lesions were 55.17%, 79.04%, and 73.46%, respectively. CONCLUSION: Although there are a few limitations of FNAC such as low cellularity, small representative sample, and hemorrhagic aspirate, it can still be used as an initial diagnostic modality with proper clinical context for the management of bone lesions.

Synchronous Primary Endometrial and Fallopian Tube Carcinoma with Metchronous Renal Pelvis Carcinoma in One Patient: "Triple Cancer- A Rare Occurrence".

Triple primary cancers in one patient are a very rare finding and occur in only 0.5% of patients with cancers. Here, we report the case of triple malignancy in a 62-year-old woman who developed synchronous primary endometrial endometroid type and serous type of fallopian tube carcinoma, which is again a rare finding after 4 years of diagnosis of transitional cell carcinoma of the right renal pelvis.

Pleural effusion: Role of pleural fluid cytology, adenosine deaminase level, and pleural biopsy in diagnosis.

OBJECTIVE: The present study is designed to evaluate the role of pleural fluid analysis in diagnosing pleural diseases and to study the advantages and disadvantages of thoracocentasis and pleural biopsy. MATERIALS AND METHODS: We prospectively included 66 consecutive indoor patients over a duration of 1 year. Pleural fluid was collected and cytological smears were made from the fluid. Plural biopsy was done in the same patient by Cope needle. Adequate pleural biopsy tissue yielding specific diagnosis was obtained in 47 (71.2%) cases. RESULTS: Tuberculosis was the commonest nonneoplastic lesion followed by chronic nonspecific pleuritis comprising 60% and 33.3% of the nonneoplastic cases respectively and tuberculosis was predominantly diagnosed in the younger age group. Majority (70.8%) of malignancy cases were in the age group of >50-70. Adenocarcinoma was found to be the commonest (66.7%) malignant neoplasm in the pleurae followed by small-cell carcinoma (20.8%). CONCLUSION: Pleural biopsy is a useful and minimally invasive procedure. It is more sensitive and specific than pleural fluid smears.

Giant cell tumor of soft tissue: Cytological diagnosis of a case.

Giant cell tumors of soft tissue (GCT-STs) are rare neoplasms and are mainly seen in adults and in the elderly population, usually in the extremities. When evaluated along with clinical features, the cytological features are sufficient to distinguish GCT-STs from other more common tumors with giant cell morphology. We report here a case of a giant cell tumor of soft tissue diagnosed on the basis of fine needle aspiration cytology and confirmed after histopathology.

Plasmacytoma with amyloidosis masquerding as tuberculosis on cytology.

Amyloid material on lymph node cytology smears can mimic caseous necrosis. We report one such case where a 50-year-old lady presented with a nasal mass and cervical lymphadenopathy. Fine needle aspiration cytology smears of the cervical lymph node were interpreted as tuberculous lymphadenitis based on the presence of an occasional epithelioid cell and caseous material. The patient did not respond to antituberculous therapy and was revaluated. Repeat aspiration from the lymph node showed numerous plasma cells and myeloma cells in addition to the amorphous material which was confirmed to be amyloid on staining with congo red. A diagnosis of plasmacytoma with amyloidosis was rendered. Imprint smears from nasal mass, detailed hematology workup and subsequent histology confirmed the diagnosis.

Cytodiagnosis of herpes simplex mastitis: Report of a rare case.

Herpes simplex virus (HSV) is a rare cause of breast infection. Few cases of maternal-infant transmission of the virus during breastfeeding resulting in nipple lesions have been documented. Only three cases have been reported in nonlactating women. We report an additional case of HSV mastitis in a 36-year-old nonlactating female who was diagnosed on scrape cytology smears.