Efficacy of Fine-Needle Aspiration Cytology in Diagnosing Secretory Carcinoma of Salivary Gland: A Systematic Review and Meta-Analysis.

INTRODUCTION: The diagnosis of salivary gland secretory carcinoma (SC) in fine-needle aspiration specimens is challenging because its low-grade nature makes it difficult to differentiate it from various benign or malignant salivary gland neoplasms. Currently, the gold standard is demonstration of ETV6-NTRK3 fusion gene. However, the decision for ordering this costly molecular testing can be facilitated by the correct recognition of its cytomorphological features. The aim of the review was to determine the accuracy of fine-needle aspiration cytology (FNAC) in diagnosis of salivary gland SC. The secondary objective was to recognize varied cytomorphological patterns, characteristic features of SC and differentiate it from other neoplasms. METHODS: PubMed/MEDLINE, Science Direct, Embase, Cochrane review, and PROSPERO databases were searched for studies having the following key search terms: ("secretory carcinoma of salivary gland" OR "mammary analogue secretory carcinoma of salivary gland") AND ("Cytology" OR "Cytological features" OR "aspirate" OR "cytodiagnosis") published in the time frame of 2010 to June 2023. Studies reporting cytological features of the salivary gland tumors which were confirmed/diagnosed as SC on molecular investigation, were included in the systematic review. Finally, seventeen studies reporting a total of 45 cases were included in the metanalysis. RESULTS: The sensitivity of the FNAC in diagnosing SC in salivary gland is 27.7% (95% CI: 16.6-42.5%). The LR+ (positive likelihood ratio) was 0.654 (0.344-1.245), LR- (negative likelihood ratio) was 1.023 (0.538-1.946), and diagnostic odds ratio was 0.421 (0.129-1.374). The molecular testing and/or immunohistochemistry performed on cell block increased the diagnostic accuracy. CONCLUSION: Recognition of subtle cytomorphological patterns, i.e., papillary formation, clusters, and singly dispersed cells along with presence of fine intracytoplasmic vacuolations were the characteristic findings in majority of cases, confirmed with diagnostic molecular profiling. This may be helpful in identification of this rare entity with limited published literature and help in increasing diagnostic accuracy.

Prognostic role of PD-L1 expression in head and neck squamous cell carcinoma: An institutional experience from India.

BACKGROUND: Squamous cell carcinoma accounts for > 90% of Head and neck cancers and has a poor 5-year survival rate of only 50%. Immunosuppressive agents like PD-L1 inhibitors have been found to improve survival in many tumour types, including advanced/recurrent head and neck squamous cell carcinoma (HNSCC). The PD-L1 expression in this tumour can also predict clinical outcome. However, this fact still remains to be proven. AIM: The aim was to study the expression of PD-L1 in HNSCC, correlate with clinicopathological parameters and outcome. MATERIAL AND METHOD: This prospective study was conducted between March 2021 to June 2023 in department of Pathology of a tertiary care centre located in northern India. A total of 65 histologically confirmed cases of HNSCC were included. Expression of PD-L1 was determined by immunohistochemistry. The combined positive (CPS) and tumour proportion (TP) scores were calculated. The results were correlated with clinicopathological parameters and outcome using appropriate statistical tools. RESULTS: Considering CPS, 42 (64.6%) cases showed expression of PD-L1. A high score of ≥ 20% was seen in 10 cases (15.4%). PD-L1 expression did not correlate with any of the clinical parameters including age, gender, addiction, site, TNM stage and HPV status. Conventional HNSCC had significantly higher expression of PD-L1. The cases with positive PD-L1 expression had a higher mean survival and a lower mortality, but the difference was not statistically significant. CONCLUSION: PD-L1 expression is more likely to be seen in conventional HNSCC histomorphology. PD-L1 expression is a predictor of better prognosis in HNSCC.

Rhinocerebral mucormycosis: A clinicopathological analysis of COVID-19-associated mucormycosis.

Background: During the coronavirus disease 2019 (COVD-19) pandemic, the incidence of mucormycosis also increased, especially affecting individuals who have had the COVID-19 infection in the past. Aims: The aim of the study is to assess risk factors and clinical and histopathological features of mucormycosis in post-COVID-19 cases. Methods: This is a retrospective study conducted in a tertiary care COVID-19-dedicated hospital, Dehradun, Uttarakhand, India, over a period of 2 months during the COVID-19 pandemic. All surgical specimens submitted for histopathology with a suspected diagnosis of mucormycosis were included. Histopathology was considered the gold standard. All histopathologically confirmed cases were studied in detail with respect to histopathology, clinico-radiological features, and microbiological results. Results: Of 25 cases with clinical diagnosis of mucormycosis, nine were histopathologically confirmed as mucormycosis. Seven patients had diabetes, while two did not have any co-morbidity. The fungal load was heavy in 50% cases, and the proportion of necrosis was higher with diabetes mellitus, as compared to non-diabetic and non-co-morbidity patients. Angioinvasion (33.3% cases), soft-tissue invasion (44.4%), Splendor-Hoeppli phenomenon (44.4%), and neural invasion (11.1%) were also present. Mixed infection (Mucormycosis and Aspergillus species) was present in three of the cases who also had diabetes. The microbiological investigations were positive in only 55.5% cases. Conclusion: Post-COVID Mucormycosis has fatal outcomes. Early diagnosis and treatment are the key to successful treatment. Early and reliable diagnosis can be offered by histopathological examination.

Dysplastic changes secondary to cytomegalovirus-induced Lipschutz ulcer: Unraveling complexity.

Lipschutz ulcer is a rare nonvenereal condition affecting predominantly young females who are not sexually exposed and can be triggered by various infectious agents, trauma, and drugs. It presents with single or multiple painful ulcers over labia minora, labia majora, vestibule, and lower part of the vagina and may be preceded by prodromal symptoms akin to influenza or mononucleosis. Diagnosis is based on specific criteria, which include age, ulcer characteristics, and absence of immunodeficiency. Management involves reassurance, supportive measures, and in severe cases, corticosteroids. This case highlights the importance of considering cytomegalovirus as a potential causative agent in Lipschutz ulcer and a cause for dysplasia.

Medical students' perspective on online teaching during pandemic: Experience from a Government Medical College in Uttarakhand, India.

BACKGROUND: COVID-19 pandemic has forced medical education to undergo sudden metamorphosis from the traditional face-to-face education to distance online learning. This transition was dealt with a lot of infrastructure and technical difficulties from both teacher and learner ends, especially in a developing country like India. This study was conducted with the aim of analyzing students' perspective and problems faced in the live online teaching. MATERIALS AND METHODS: This was a prospective longitudinal study conducted on medical students enrolled in the 1st, 2nd, and 3rd years of Bachelor of Medicine and Bachelor of Surgery courses at a government medical college located in hilly state Uttarakhand, India. Clearance from the institutional ethical committee was obtained. The students were invited to voluntarily participate in online survey by filling Google Forms which was E-mailed as well as shared in social media platform. A total of 237 medical students participated. The first survey was conducted at the time of initiation of online mode of teaching, during May 1-7, 2020, and second, after completion of 6 months of regular online teaching, during November 1-7, 2020. The questionnaire comprised initial section on demographic details and consent followed by 27 and 30 sets of statements pertaining to online medical education experience in the first and second questionnaires, respectively. A 5-point Likert scale was used. Data were analyzed using IBM SPSS version 24.0. Chi-square test was applied for association, and P ≤ 0.05 was considered statistically significant. RESULTS: A total of 237 students participated in the study. The response rate was 52.7%. Majority of respondents had suitable devices (89.1%) and Internet facilities (62%) for online classes. The students accepted the new method of teaching very well, but for practical sessions and clinics, traditional classes were necessary. Long screen time, lack of student-teacher interaction, and interaction with peers were major concerns of students. However, over the study period, the availability of resources, friendliness toward technology, and inclination toward virtual classes increased. CONCLUSIONS: The pandemic has introduced to a new normal where online teaching cannot be ignored. Despite challenges faced during online learning, 65.5% of students preferred hybrid teaching in future for delivering medical education. Acceptance for online education by students increased over time in the study.

Role of CD71 in acute leukemia- An immunophenotypic marker for erythroid lineage or proliferation?

BACKGROUND: CD71 or Transferrin receptor is expressed on the surface of erythroid lineage cells. CD71 expression has been found to be significantly increased in rapidly proliferating cells. METHODS: This cross-sectional study included 37 bone marrow samples of acute leukemia cases diagnosed between October 2016 to April 2018. The samples were analysed on BD FACS Canto II. We evaluated the expression of CD71 on leukemic blasts and compared median fluorescent intensities (MFI) of blasts in different types of acute leukemias. RESULTS: The 37 cases comprised of 21 Acute Myeloid Leukemia (AML), 13 B-Acute Lymphoblastic Leukemia (B-ALL), 2 T- Acute Lymphoblastic Leukemia (T-ALL) and 1 mixed phenotypic acute leukemia (MPAL), T/Myeloid. CD 71 expression was noted in 70.3% (n= 26/37) of acute leukemia cases. CD71 expression was most commonly observed in AML (n= 15/21;71.4%), followed by B-ALL (n= 9/13;69.2%) and T-ALL (n= 1/2;50%). Single case of MPAL revealed blasts positive for CD71. MFI of leukemic blasts of single CD71 positive T-ALL was found to be highest, followed by AML, MPAL (T/Myeloid) and least in B ALL. Of the AML cases, the blasts of AML-M6, acute promyelocytic leukemia and AML-M1 showed higher CD71 expression in terms of MFI. CONCLUSIONS: Surface CD71 expression is not only found in erythroid lineage cells, but also in proliferating cells. CD71 MFI is highest in T lymphoblasts followed by leukemic erythroblasts, myeloblasts and least in B lymphoblasts.

Primary epithelial splenic cyst: A rare encounter.

Splenic cysts are rare with an overall incidence of 0.07% in a large autopsy series and 0.5% among all the splenectomies done. The parasitic splenic cysts, usually caused by Echinococcus granulosus, account for 60% of all primary splenic cysts. The primary epithelial cysts account for 10% of all splenic cysts. We report a case of 30-year-old female presenting with left upper abdominal pain and heaviness. Computed tomography revealed a multiloculated cyst in spleen. Hydatid serology was negative. Total splenectomy was done. Histopathological evaluation was done and a diagnosis of primary epithelial splenic cyst was given.

Neuroendocrine Carcinoma of Gall Bladder: A Rare Presentation with Review of Literature.

Neuroendocrine tumors are the rarest tumors of gallbladder. The most aggressive variant is neuroendocrine carcinoma which presents in about 0.5% of all gallbladder carcinomas and 0.2% of all neuroendocrine tumors. It seems possible that survival rates can be improved by utilizing wide surgical resection combined with chemotherapy. We report a case of neuroendocrine carcinoma of gall bladder in a 20-year old female patient. In present case, the etiology was not known as patient did not have cholelithiasis or any symptoms related to chronic inflammation. Our extensive search of indexed literature shows that our patient was the youngest patient with this disease so far.

Fine-needle aspiration cytology as a diagnostic modality for cysticercosis: A clinicocytological study of 137 cases.

BACKGROUND: Cysticercosis, a parasitic tissue infection caused by the larva of Taenia solium, is quite a common disease in our part of the world, but its incidence is often underestimated. Fine-needle aspiration cytology (FNAC) plays an important role in early detection of this disease, especially when the lesion is located in anatomically approachable superficial locations. AIMS: The aim was to study role of FNAC in the diagnosis of cysticercosis. MATERIALS AND METHODS: In this retrospective study, the data of 137 patients with palpable nodules, who were diagnosed as having or suspicious of cysticercosis on FNAC, were retrieved and analyzed. RESULTS: In 129 (94.2%) cases, a definitive diagnosis of cysticercosis was obtained in the form of parts of parasite tegument, hooklets, parenchymatous portion and calcareous corpuscles. In the background, giant cells, mixed inflammatory cells, and epithelioid cells were present. In remaining 8 (5.8%) cases, larval fragments could not be identified on the aspirates, and the diagnosis of parasitic inflammation was suggested on the basis of other cytological findings such as clear fluid aspirate, presence of eosinophils, histiocytes, foreign body giant cells, a typical granular dirty background, etc. Follow-up biopsy in these 8 cases confirmed the diagnosis of cysticercosis in 7 (87.5%) while in 1 (12.5%) case, histopathology was suggestive of parasitic cyst. CONCLUSION: Fine-needle aspiration cytology in cysticercosis is a low-cost outpatient procedure. The cytological diagnosis is quite straightforward in cases where the actual parasite structures are identified in the smears. In other cases, a cytological diagnosis of suspicious of cysticercosis can be given if the cytological findings suggest the same.

Isolated Echinococcosis of cervical region.

Echinococcosis, commonly called as hydatid disease, is a parasitic infestation caused by the larva of the genus Echinococcus in human. Isolated occurrence of Echinococcosis without any evidence of visceral disease is very rare. A thorough search of the literature revealed only 11 cases of isolated cervical Echinococcosis. We report here a very rare case of isolated hydatid cyst in a 45-year-old female patient, who presented with swelling in right cervical region about 5 cm below the angle of mandible with no evidence of the disease elsewhere in the body. The case was diagnosed on fine needle aspiration cytology. The diagnosis was further supported by histopathology. We propose that the treating physician should also consider the differential diagnosis of Echinococcosis in the presence of an asymptomatic soft tissue mass, especially when the patient lives in an endemic area.

Isolated cysticercosis of tongue: a case report.

Cysticercosis of the tongue is a rare disease caused by infestation with the larval stage of the pork tapeworm (Taenia solium) in which man acts as a secondary host rather than a primary host. Most of these lesions are asymptomatic. The patient usually reports to the physician with the complaint of swelling. The solitary swelling in the tongue of this young 12-year-old girl was not suspected clinically for cysticercosis. Fine needle aspiration cytology, used for pre-operative diagnosis, suggested the possibility of cysticercosis. Detailed medical evaluation was carried out which ruled out neural cysticercosis and other extraneural lesions. The complete removal of the lesion was achieved by simple excision. The histopathological examination confirmed the diagnosis of lingual cysticercosis.

Incidental Diagnosis of Filariasis in Superficial Location by FNAC: A Retrospective Study of 10 Years.

BACKGROUND: Filariasis, transmitted by the bite of various species of mosquito, is a common disease of tropical belt of the world. In South East Asia, including India, it is a major public health problem. The parasite is primarily confined to Lymphatic channel or lymph nodes where it can remain viable for more than two decades. The most common presentation of the disease is asymptomatic/ subclinical microfilaremia, Hydrocele, acute adeno-lymphangitis (ADL) and chronic lymphatic disease. However, the disease may rarely present as superficial swellings at unusual sites. Incidental findings of microfilaria on fine needle aspiration cytology in these situations, helps in prompt recognition of the disease. AIM: The aim of this retrospective study was to assess the incidental diagnosis of Filariasis on fine needle aspiration cytology (FNAC), done for swellings in superficial locations over last ten years at our institute. MATERIALS AND METHODS: This retrospective study was conducted over a period of 10 years from April 2003 to March 2013 on the cases where FNAC was carried out on swellings in superficial locations of the body. Twenty cases of filariasis were diagnosed on routine FNAC material obtained from various superficial sites. Their data was retrieved and analyzed. RESULTS: Among the 20 cases diagnosed as filariasis on FNAC, six cases involved lymph nodes, six involved testiculo-scrotal region, three cases of thyroid swelling, soft tissue swelling in three cases and breast lump in two cases. On FNA smears, microfilariae were seen in all 20 cases, eggs in three cases, adult female worm in two cases and adult male worm in one case. Adherence of inflammatory cells and macrophages to microfilariae was noticed in 4 cases. Eosinophilia was present in seven cases. Microfilaremia was present in only three cases. Causative agent was Wuchereria bancrofti in all cases. CONCLUSION: Although not so common, filariasis should be considered as one of the differential diagnosis of a superficial swelling particularly if clear fluid is obtained on FNAC. Careful screening of smears plays a significant role in recognition of the disease even in asymptomatic patients.

Benign pairs: a significant entity in aspiration cytology smears from breast lesions.

INTRODUCTION: Fine needle aspiration cytology (FNAC) is a reliable diagnostic tool used to diagnose breast lesions preoperatively. However, FNAC is also associated with diagnostic pitfalls. Further studies are needed to improve its diagnostic efficacy. We noticed ovoid, bare nuclei arranged in closely touching diads (benign pairs) in a significant number of cytology smears. This prompted us to assess their diagnostic utility. MATERIALS AND METHODS: This was a prospective study conducted in Sarojini NaiduMedical College, Agra, India. Quantitative estimation of benign pairs per 1000 ductal cells in at least 20 high power field was attempted in cytology smears of 128 cases. RESULTS: The average number of pairs in benign and malignant lesions was calculated as 7.07 + 5.96 and 0.28 + 0.78, respectively. Statistical analysis showed a significant difference between the number of pairs in benign and malignant cases (P < 0.0005). CONCLUSIONS: Quantitative estimation of benign pairs is helpful in distinguishing benign from malignant cases.