Alveolar soft part sarcoma: A case report and review of the literature.

Alveolar soft part sarcoma (ASPS) is a rarely diagnosed tumour of deep soft tissue origin. This tumour is more common in adolescents and young adults and has a slowly progressive clinical course, which often leads to delayed diagnosis and treatment. It is highly vascular, can be confused with other entities like haemangiomas and arteriovenous malformations clinically and radiologically and is thus challenging to report on fine needle aspiration cytology (FNAC). Diagnosing the tumour is difficult on cytology, so knowledge of this entity and the differentials with its morphological mimics on cytology is required for timely diagnosis and early management of the patient. We report a case of ASPS in a young female who presented with a large, painless swelling in the thigh, diagnosed on cytology combined with ancillary testing with immunohistochemical markers.

Diagnostic utility of rapid on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration samples: A study in a region of high tuberculosis burden.

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool for precise diagnosis of thoracic lesions. However, the procedure sometimes has a poor yield. Rapid on-site evaluation (ROSE) in EBUS-TBNA has been shown to be helpful to improve its diagnostic yield and minimise the need for repeat procedures. Most of the studies that have evaluated the utility of ROSE have focused on malignant lesions; however, it is important to understand its utility in benign lesions, particularly in a country with a high tuberculosis burden. OBJECTIVE: This study was undertaken to evaluate the utility of ROSE in EBUS-TBNA for the diagnosis of patients presenting with mediastinal lymphadenopathy and/or thoracic mass for benign and malignant pathologies. METHODS: This was a prospective study including 47 patients who underwent EBUS-TBNA for thoracic lesions (lung masses and hilar/mediastinal lymphadenopathy) over a 10-month period at a single tertiary care centre. In addition to ROSE and definitive cytology, the aspirated material was also sent for cell block and microbiological studies. Endobronchial/transthoracic biopsy was conducted for histopathological evaluation (HPE) where required, at the discretion of the clinician. ROSE diagnosis was then compared with the final diagnosis. RESULTS: Of the 47 patients examined using ROSE, granulomas were observed in 33 cases, non-specific inflammation in six cases, and malignancy in five cases; one case was inconclusive and the sample was found to be inadequate in two cases. The ROSE assessment matched the final diagnosis in 84.45% patients. CONCLUSION: ROSE is a simple procedure that is able to provide an immediate and accurate assessment of adequacy and has a significant yield, enabling a preliminary diagnosis to be made in both benign and malignant samples.

Cytological diagnosis of microfilariae in clinically unsuspected cases: A retrospective review of 12 cases.

BACKGROUND: Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies. AIMS AND OBJECTIVES: This study was undertaken to analyse the prevalence and cytological findings of cases of incidentally found microfilariae in cytology smears (fine needle aspiration cytology [FNAC]/exfoliative cytology) from different parts of the body. MATERIALS AND METHODS: This was a retrospective study over 3 years, in which cases of microfilariae in aspirates from swelling of different locations, body fluids, and pap smears were reviewed, and the clinicopathological data analysed. RESULTS AND ANALYSIS: Out of 11 530 cases of FNAC, 8700 cases of fluid cytology, and 9000 of conventional cervicovaginal smears, 12 cases (0.04%) of incidental findings of microfilariae were documented in cytology smears. The cases were diagnosed from lymph node (one case), hand (one case), scrotal area (one case), axilla (one case), breast (one case), subcutaneous tissue (three cases), urine (three cases), and Pap smear (one case). We found eosinophilia in one case (8.3%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions. CONCLUSION: Cytology smear examination can play an important role in diagnosing occult filariasis in clinically unsuspected cases in association with other pathologies.

Cytomorphological spectrum of cysticercosis: A study of 26 cases.

BACKGROUND: Cysticercosis is a systemic parasitic disease caused by the larval stage of Taenia solium. It is the most common parasitic disease worldwide. Fine needle aspiration cytology can play an important role in prompt recognition of this disease. OBJECTIVE: To study the role of FNAC in the diagnosis of cysticercosis. MATERIALS AND METHODS: This study included 26 patients with parasitic infestation who presented with palpable subcutaneous and intramuscular nodules at different sites. Their clinical presentations and fine needle aspiration cytomorphological features are reported. RESULTS: The age range of these patients was 7-60 years. The majority were males. The most commonly affected site was head and neck followed by upper extremity. Most of the cases were clinically misdiagnosed as lipomas, neurofibromas, lymphadenitis, epidermal inclusion cyst, sialadenitis, and soft tissue tumours. The aspirate was clear fluid in the majority of cases. All of the cases revealed fragments of bladder wall with associated granulomas in seven cases and giant cells in four cases. However, none of the case revealed hooklets. CONCLUSION: Fine needle aspiration cytology can provide a simple, minimally invasive, low-cost, outpatient diagnostic technique for the diagnosis of cysticercosis, as cytological diagnosis is quite clear when the actual parasitic structures are identified in the smear.

Fine-needle aspiration cytology of periarticular nodule - Atypical presentation of gouty tophi: A report of two cases.

Gout is a chronic arthropathy caused due to the deposition of monosodium urate crystals. Gouty tophus can be the initial presenting feature of gout with or without any clinical symptoms. Demonstration of urate crystals in synovial fluid or biopsy helps in confirming the diagnosis of gout. However, fine-needle aspiration cytology (FNAC) of periarticular soft-tissue nodules is a valuable tool in the diagnosis of gout. We present two such cases of isolated soft-tissue lesions wherein the initial diagnosis of gouty tophus was made on FNAC and subsequently followed by a clinical and biochemical workup.

Papillary tumor in pineal region: Immunohistochemistry meeting the diagnostic challenge.

Papillary tumor of pineal region (PTPR) is extremely rare and poses diagnostic challenge with other central nervous system tumors having papillary architecture. Immunohistochemistry is crucial for a definitive diagnosis of PTPR.

Isolated Epitrochlear Filarial Lymphadenopathy: Cytomorphological Diagnosis of an Unusual Presentation.

Filariasis is a major public health problem in tropical countries like India. Despite the large number of people at risk, detection of eggs with or without larva (microfilaria) on fine-needle aspiration cytology is very unusual, especially in an uncommon site or incidentally detected in clinically unsuspected cases of filariasis with the absence of microfilariae in the peripheral blood. A 19-year-old male presented with swelling over medial aspect of left arm (just above the elbow), with no other specific signs and symptoms. Fine needle aspiration cytology revealed an adult gravid female filarial worm in a background of reactive lymphoid cells and lymphohistiocytic clusters. We report a case with elaborate fine needle aspiration cytology findings of filarial worm infestation with unusual presentation of isolated epitrochlear lymph node involvement in a clinically unsuspected case and recommend clinicians and pathologists to consider a high index of suspicion for such infections at uncommon sites especially in endemic territories, as early diagnosis and treatment prevent the more severe manifestations of disease.

Fine-needle aspiration of axillary swelling: Cytodiagnosis of an unusual presentation of filariasis.

Lymphatic filariasis is a major public health problem in tropical and subtropical countries. Fine-needle aspiration cytology (FNAC) is not routinely used for its identification. However, it has been detected incidentally, while doing FNAC for the evaluation of other lesions. We describe a presentation of occult filariasis with microfilariae (mf) in an isolated axillary swelling wherein FNAC was helpful in establishing the diagnosis.

Cerebrospinal fluid cytology of choroid plexus tumor: A report of two cases.

Choroid plexus tumors (CPTs) are relatively uncommon tumors of the central nervous system, constituting approximately 5% of all pediatric brain tumors. Although squash cytology of CPT has been described in literature, shedding of tumor cells into cerebrospinal fluid (CSF) has rarely been described. We report two such cases of atypical choroid plexus papilloma in a 5-month-old male child and a 12-year-old female child, where characteristic cytomorphology of CPT was noted in the CSF.

Dedifferentiated adenoid cystic carcinoma ex pleomorphic adenoma of the parotid.

Carcinoma ex pleomorphic adenoma (Ca ex PA) is defined as a carcinoma arising from a primary (de novo) or recurrent benign pleomorphic adenoma. The most common histological subtype is adenocarcinoma, not otherwise specified, salivary duct carcinoma, mucoepidermoid carcinoma, and adenoid cystic carcinoma (ACC). Few case reports of de novo dedifferentiation in ACC are there in the literature, mostly involving minor salivary glands. The dedifferentiated adenoid cystic carcinoma arising in a pleomorphic adenoma of the parotid gland has not been reported earlier. The present case highlights this rare histological subtype seen in Ca ex PA and the role of extensive histopathological examination and immunohistochemistry.

Sinonasal malignant melanoma with metastasis: Immunohistochemistry meeting the diagnostic challenge.

Sinonasal malignant melanoma is one of the uncommon and highly aggressive tumors of the sinonasal cavity. Cytomorphological features in a metastatic lymph node may reveal a diagnosis of malignant melanoma. This case had nondiagnostic cytological and histopathological features, which could suggest malignant melanoma. Immunohistochemistry in such cases becomes the primary method for establishing the diagnosis of malignant melanoma at an uncommon site.

Cytodiagnosis of Rosai-Dorfman disease masquerading as lymphoma: A case report with brief review of literature.

Rosai-Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy (SHML) is a self-limiting, benign histiocytic disorder. We report a case of RDD mimicking lymphoma clinically and cytologically in a 3-year-old male child. The present case highlights the importance of cytology in the diagnosis of RDD along with cytological features of other differential diagnoses.

Primary cutaneous non-Hodgkin's lymphoma, clinically mimicking a soft tissue sarcoma.

Primary cutaneous B-cell lymphomas (PCBCL) are a heterogeneous group of neoplasms with distinct biology and clinical course when compared to their nodal counterparts. They usually present as violaceous, erythematous plaques, and nonulcerated nodules, which are confined to skin at the time of presentation. We present an unusual case of primary cutaneous diffuse large B-cell lymphoma, clinically mimicking a sarcoma. This case highlights the uncommon aggressive behavior and ulcerated type of nodular lesions seen in PCBCL and also revisits the cytomorphological findings of the same.

Cytodiagnosis of extramedullary hematopoiesis in serous effusion: A rare presentation unfolding the underlying etiology.

Extramedullary hematopoiesis (EMH) usually involves reticuloendothelial system. However, it rarely may be present in the serous body effusions. In our case, the fluid cytology of both peritoneal and pleural fluid was diagnostic of the EMH in a patient with an undiagnosed underlying etiology.

A cytologic perspective on meibomian gland carcinoma.

OBJECTIVE: To reevaluate and reestablish the reproducible diagnostic cytomorphologic features of meibomian gland carcinoma (MGCA), demonstrating the importance of fine needle aspiration cytology (FNAC) in eyelid lesions and leading to better management of the tumor. STUDY DESIGN: Cytologic smears ofpreviously diagnosed cases of MGCA over a 3-year period were collected, along with their histopathology reports. The cytomorphology of the histopathologically proven cases were reevaluated in greater detail. The cytologic smears were stained with Leishman-Giemsa cocktail and Papanicolaou stain, and the histopathologic sections were stained with hematoxylin-eosin. Special stains and immunohistochemical stains were applied as required. RESULTS: Of the 19 cases, 3 diagnosed as MGCA on cytologic examination were reported as basal cell carcinoma on histopathology. On reevaluation of the cytologic smears, in addition to the regular characteristic features of MGCA, interesting findings such as an isolated dispersed cell population in a bubbly background, signet ring cells, pseudo-mucin cell balls, giant cell reaction and hyaline-like round bodies were observed. CONCLUSION: This study emphasizes the cytomorphologic features of MGCA in addition to those described in the literature, which could be of a great help in its diagnosis. Further, it emphasizes the importance of FNAC in the diagnosis of MGCA.

Granular Cell Tumour of the Chest Wall: FNA Diagnosis with a Review of Literature and Elaboration of Cytological Mimickers.

Granular Cell Tumours (GCTs) are uncommon tumours which can be confused with other benign soft tissue tumours on clinical examination. Fine Needle Aspiration Cytology (FNAC) plays a significant role in their diagnosis. There are certain cytological mimickers of GCTs so a cytopathologist must be aware of its characteristic cytomorphology. These tumours can be present anywhere on the body; however, chest wall is one of the uncommon sites. We present a case of GCT present on the chest wall in an elderly male as a subcutaneous nodule. We have discussed the common cytological differential of GCTs, features of malignant GCTs along with cytomorphological and immunohistochemical features.

Reporting adverse transfusion reactions: A retrospective study from tertiary care hospital from New Delhi, India.

CONTEXT: Blood transfusion services have achieved newer heights in the last decade, with developments in cellular techniques, component separation, and integration of molecular methods. However, the system of recording and reporting of the adverse events related to blood transfusion is developing countries like India is grossly inadequate and voluntary in nature. AIMS: This study was undertaken to analyze the retrospective data on adverse events related to blood transfusions in our hospital. SUBJECTS AND METHODS: This retrospective study was done to examine all the transfusion related adverse events reported in a Regional Blood Bank Transfusion Centre of North India over a period of 9 years. Adverse transfusion events related to whole blood, red cell concentrates (RCCs), and all other components were analyzed and classified on the basis of their clinical features and laboratory tests. Average rate of transfusion reactions with the components was also assessed. STATISTICAL ANALYSIS USED: Categorical variables were analyzed using the Chi-square test. P < 0.05 was taken to indicate a significant difference. RESULTS: During this period, a total of 1,60,973 blood/blood component units were issued by our blood bank to various departments of the hospital and 314 immediate transfusion events were reported. The rate of immediate transfusion reactions during the study was 0.19%. Average transfusion reaction rate with RCC was 0.25% with febrile nonhemolytic reactions being the most common type of adverse event (37.2%). CONCLUSIONS: Awareness should be increased among clinicians to correctly prevent, identify, and report transfusion-related adverse events. These measures should be implemented to increase blood transfusion quality and safety.

The thyroid: an extremely rare primary site of neuroblastoma.

Neuroblastoma (NB) is uncommon in the adolescent age group. It is located at any site containing sympathetic neural tissue, with retroperitoneal and adrenal lesions being the most common. Cutaneous and subcutaneous metastases of NB in children are infrequent. Primary thyroid NB with regional lymph node and distant multiple subcutaneous metastases was diagnosed in an 11-year-old boy. The differential diagnosis was primitive neuroectodermal tumor. Our case demonstrates the unique presentation of NB in an adolescent.

Diagnosis of isolated tuberculous orchitis by fine-needle aspiration cytology.

An isolated tuberculous Orchitis without epididymal involvement is rare. This case report describes an extra pulmonary tuberculosis with exclusively testicular presentation. The confirmatory diagnosis of which was made on FNAC of the testis. A 22-year-old adult presented with unilateral testicular enlargement and scrotal ulcer on the same side. FNAC was performed and subsequent smear examination revealed epitheloid granuloma in a necrotic background. This was suggestive of tubercular orchitis, which was further confirmed by demonstration of very occasional acid fast bacilli in the smear. Isolated tuberculous orchitis is a rare entity; FNAC is a useful first choice of investigation. It provides a successful diagnosis thereby preventing unnecessary orchidectomy.