A Comparative Study on Fine Needle Aspiration Cytology versus Fine Needle Capillary Cytology in Thyroid Nodules.

OBJECTIVES: Fine needle aspiration cytology (FNAC/FNA) is the primary investigation for thyroid nodules. Fine needle capillary cytology (FNCC/FNC) is an alternative technique not commonly used, though it is easy to perform. Both the techniques have their own advantages and disadvantages. This study aims to compare these two cytological techniques for better specimen and cytological diagnosis. METHODS: This prospective study was conducted on 50 patients attending the FR Muller Medical College Hospital from May 2006 to April 2008. The patients with thyroid nodules (diagnosed by palpation) were subjected to both the cytological techniques; FNA and FNC. The specimen and results were compared and then correlated with the final histopathological findings wherever surgical specimens were available (38 cases). RESULTS: The mean age of the patients was 39.16 with a female predominance. The majority of cases were diagnosed to have nodular goiters. The FNC technique yielded 88% diagnostic superiority and adequate specimens compared to 94% by FNA. Sensitivity was 50% for FNC and 100% for FNA while specificity was 100% for both techniques; accuracy score was 97.4% for FNC and 100% for FNA in predicting malignancy. While sensitivity was 75% for FNC and 100% for FNA; specificity was 100% for both techniques, and accuracy score was 97.4% for FNC and 100% for FNA in the prediction of neoplasia. CONCLUSION: The results indicated that there was no significant difference between the two techniques; if done in tandem can give better and accurate cytological diagnosis. In highly cellular lesions, in which abundant material was obtained, FNC was more likely to be diagnostically superior, but FNA can diagnose most of the lesions. In less cellular lesions, FNA is more likely to be diagnostically superior to FNC.

Tuberculous mastitis presenting as breast abscess.

Tuberculous mastitis is a rare clinical entity and usually affects women from the Indian sub-continent and Africa. It often mimics breast carcinoma and pyogenic breast abscess clinically and radiologically, may both co-exist. Routine laboratory investigations are not helpful in its diagnosis. Fine needle aspiration cytology (FNAC) / biopsy are essential for diagnosis and tuberculosis culture when positive may be very useful to guide antimicrobial therapy. Antitubercular drugs in combination with aspiration or surgical drainage are usually associated with an excellent outcome.

Primary tuberculosis of submandibular salivary gland.

Tuberculosis of the submandibular salivary gland is a rare condition and only a few cases have been reported in literature. Tubercular sialadenitis is most frequently seen in immunosuppressed patients. Diagnosis of this disease is difficult. Although fine needle aspiration cytology is useful in diagnosis, excisional biopsy is often required. Polymerase chain reaction for mycobacterium tuberculosis is a reliable diagnostic tool, and if available, it should be performed before surgical intervention to enable differential diagnosis of a salivary gland tumor. We report two cases of the submandibular salivary gland tuberculosis from South India (Mangalore located in the coastal belt of Karnataka) that proved diagnostically challenging. Both patients responded well to antitubercular therapy and surgery was avoided.

Asymptomatic Meckel's diverticulum in adults: is diverticulectomy indicated?

BACKGROUND/AIM: The objective of this study was to estimate the incidence of the Meckel's diverticulum (MD) and to study its clinical profile and surgical outcome, as well as to check whether diverticulectomy is indicated for asymptomatic MD in adults. MATERIALS AND METHODS: This is a prospective study of 1332 patients who were operated upon for acute abdomen during the period August 1999 to July 2009 in a single surgical unit. Preoperative abdominal ultrasonography and plain x-ray abdomen (erect) were done depending on the necessity. These patients were subjected to laparotomy/ appendicectomy depending on the case. A search for MD was done, and if found, surgical resection and analysis by histopathological confirmation of the resected MD were performed. RESULTS: During the operation, this study detected 15 (1.13%) patients with MD. In none of these cases, preoperative diagnosis of Meckel's diverticulitis was made. The age of the patients ranged from 18 to 68 years (mean age, 32.9 years). Out of 15 patients, 9 (60%) were males; 6 (40%) were females. Seven (46.7%) cases were symptomatic due to MD and 8 (53.3%) were asymptomatic. One patient presented with hematochezia; 2, with intestinal obstruction due to gangrene of the MD; and 4, with Meckel's diverticulitis. One patient had duplication of (double) Meckel's diverticulum without any inflammation in both the diverticulae. Histopathological examination of these specimens confirmed 4 cases with inflammation; 2, with gangrene; and 1, with ulcerated gastric mucosa in the MD. Among these, in 2 (13.3%) cases there was heterotopic epithelium (ulcerated gastric mucosa- 1, colonic mucosa- 1). CONCLUSION: We recommend that a search for MD in every case of appendicectomy/ laparotomy done for acute abdomen should be conducted, and if found, Meckel's diverticulectomy or resection should be performed to avoid secondary complications arising from it.

Primary Tuberculosis of the Appendix.

Primary (isolated) tuberculosis of the appendix is a clinical rarity, its reported incidence being 0.1 to 0.3%. Diagnosis is often made only after histopathological examination of resected specimen. This report describes two patients with clinical diagnosis of acute appendicitis and appendicular mass respectively, who were finally diagnosed to have tuberculosis of the appendix on histopathological examination. This article stresses the importance of histopathological examination of resected appendix.

Primary lymphoma of the colon.

Primary lymphoma of the colon is a rare tumor of the gastrointestinal (GI) tract and comprises only 0.2-1.2% of all colonic malignancies. The most common variety of colonic lymphoma is non-Hodgkin's lymphoma (NHL). The GI tract is the most frequently involved site, accounting for 30-40% of all extra nodal lymphomas, approximately 4-20% of which are NHL. The stomach is the most common location of GI lymphomas, followed by the small intestine. Early diagnosis may prevent intestinal perforation; however, the diagnosis is often delayed in most cases. Therapeutic approaches described in two subsets include: Radical tumor resection (hemicolectomy) plus multi-agent chemotherapy (polychemotherapy) in early stage patients, biopsy plus multidrug chemotherapy in advanced stage patients. Radiotherapy is reserved for specific cases; surgery alone can be considered as an adequate treatment for patients with low-grade NHL disease that does not infiltrate beyond the sub mucosa. Although resection plays an important role in the local control of the disease and in preventing bleeding and/or perforation, it rarely eradicates the lymphoma by itself. Those with limited stage disease may enjoy prolonged survival when treated with aggressive chemotherapy.

Non-contact lens related Acanthamoeba keratitis at a tertiary eye care center in south India: Implications for eye care programs in the region.

BACKGROUND: The purpose of our research was to determine diagnosis and outcomes for non-contact lens related Acanthamoeba keratitis in south India. MATERIAL/METHODS: A retrospective review of the medical and microbiology records of culture-positive Acanthamoeba cases presenting between 1987 and 2001 to a tertiary eye care center in south India. RESULTS: One hundred and three culture-positive cases of Acanthamoeba were identified during chart review. The majority of these cases (70.9%) were already on treatment for keratitis with antibiotics, antifungal and antiviral regimes prior to our examination; 45.2% were on different combinations of regimes. Cysts could be identified using 10% KOH mount in 83.5% of these cases. Clinical resolution with medical therapy was achieved for 83.5% of the cases; the median duration of treatment was 90.5 days. Outcomes - either clinical or visual - did not differ between CONCLUSIONS: Acanthamoeba keratitis cases presenting to this tertiary care center were non-contact lens wearers, and already on empirical treatment for either bacterial or fungal keratitis. A basic lab facility including only microscopy and smear examinations may aid etiological diagnosis of corneal ulcers, and reduce the current practice of using combinations of treatment regimes on an empirical basis.

Simultaneous bilateral fungal keratitis caused by different fungi.

Fungal keratitis is an important cause of corneal disease in the tropical world. We report a rare presentation of simultaneous bilateral corneal ulceration caused by different fungi.