Utility of anticoagulation, pre-smearing and post-smearing hemolytic techniques on morphological assessment and reproducibility in fluid cytology.

Objective: Knowledge of proper collection, storage, preservation, and processing techniques is critical to ensuring proper handling and analysis of fluid cytology specimens. This study was conducted to determine the effect of anticoagulation, pre-smearing acetic acid treatment technique, and saline rehydration technique on morphological assessment, reproducibility, and reporting in fluid cytology. Material and Methods: The study was carried out in the cytopathology laboratory over 2 months (April-May 2022), where 100 effusion samples were analyzed. At least 20-40 mL of fluid was collected in heparinized and non-heparinized containers for each patient. Samples were processed in cytospin and stained with Giemsa and Papanicolaou stains. For 70 hemorrhagic specimens, an extra smear was prepared from the sediment and subjected to the saline rehydration technique as per the Indian Academy of Cytologists (IAC) guidelines. Seventy-three hemorrhagic specimens whose quantity received was more than 35 mL were subjected to the pre-smearing technique. These smears were evaluated for (a) the presence or absence of blue background/any other background staining, (b) cellularity, (c) cell morphology and (d) the presence/absence of microclots. Results: Heparinized samples showed no compromise in cellular morphology or cellularity although a blue background was observed in an occasional case. The pre-smearing technique had less background hemorrhage and preserved cell characteristics. The post-smearing saline rehydration technique did not compromise the cellularity but distorted morphology and showed background staining. Conclusion: The pre-smearing acetic acid treatment showed better-preserved cellularity and cytomorphology with the absence of background staining when compared to the post-smearing saline rehydration technique.

Comparison of liquid based cytology and conventional smears on lymph node aspirates: A cytomorphological study.

Objective: In an era of minimally invasive and rapid diagnostic technologies, fine-needle aspiration cytology (FNAC) is most useful when it comes to patients with lymphadenopathies especially of the cervical region. Liquid-based cytology (LBC) is an alternative processing method which is used for both gynecological and non-gynecological samples. Because of the remarkable advantages of LBC smears in gynecological samples, nowadays, many studies have been done to assess its utility in various other lesions. Hereby, with the help of this study, we would like to evaluate the efficiency of LBC smears in comparison to conventional FNAC smears conventional smears (CS) on lymph node aspirates. Material and Methods: A retrospective study was done over a 1-year period in which 253 cases of lymph node aspirates were included in the study. The slides were prepared using standard conventional and LBC techniques and compared for adequacy, cellularity, cell architecture, necrosis, background debris, presence of cells in monolayer sheets, and nuclear/cytoplasmic details. Results: Of the total 253 cases, 171 (67.6%) were and 67 (26.5%) were diagnosed as non-neoplastic and malignant, respectively. Although the LBC smears were useful in the diagnosis of malignant cases, they did pose some challenges especially in the non-neoplastic lymph node aspirates due to loss of the background necrosis. In addition, the cellular yield in LBC smears was low in comparison to CS. Conclusion: LBC smears from lymph node aspirates results in better diagnostic accuracy for malignant cases due to better cellular and nuclear details. However, for non-neoplastic etiology, it should not be considered better than CS as loss of the background necrosis and inflammation may result in an incorrect diagnosis.

Cytomorphology of skin adnexal tumors and its correlation with histopathology in a tertiary care center.

Objectives: Even though fine-needle aspiration cytology (FNAC) can be successfully used for describing the cytomorphology of skin adnexal tumors and can help in identification of them as benign or malignant, histopathology remains the gold standard in confirmation of diagnosis. Skin adnexal tumors are a large and diverse group and are relatively less commonly encountered in routine practice; hence, knowledge of cytological features of these lesions is crucial for their appropriate management. The present study aims to evaluate the cytomorphological features of skin adnexal tumors on FNAC smears and their correlation with the histopathology. Material and Methods: This is a retrospective study of FNAC of 60 cases of subcutaneous and dermal swellings over a period of 4 years from August 2018 to August 2022 in a tertiary care center. Results: In the 60 cases of skin adnexal tumors evaluated, most cases were within the 2nd to 4th decade with male predominance. The FNA smears were helpful in picking up the nature of skin adnexal tumors, as in our case series, malignant lesions were 8.3% and benign were 91.7%. Majority adnexal lesions were of follicular or sebaceous differentiation. Histological diagnosis was available in 38 cases. Cytological diagnosis in 34 cases was concordant with histopathology. There was discrepancy observed in two cases which were reported as benign skin adnexal tumor but later turned out to be sebaceous carcinoma on histopathology. Conclusion: Even though histopathology being the gold standard for confirmation of diagnosis, in the current era of minimally invasive procedures, FNAC stands out as a valuable modality and can be a promising alternative to diagnose skin adnexal tumors and understand their cytomorphology as the data are limited about it.

Histomorphological Evaluation of Desmoplastic Tumor Stroma in Malignant Ovarian Surface Epithelial Tumors.

Background: Ovarian cancer is the 8th most common cancer in women worldwide. Tumor budding is defined as a type of invasive growth in carcinomas with either a single tumor cell or a cluster of up to four cells at the invasive tumor front and is associated with epithelial-mesenchymal transition. A reactive stroma rich in cancer-associated fibroblasts is associated with higher tumor grade and poorer prognosis in breast, colorectal, and oral cancers. Aims and Objectives: The present study was conducted to highlight the prognostic significance of tumor budding and fibrotic cancer stroma in malignant ovarian surface epithelial tumors with known prognostic parameters. Materials and Methods: This was a retrospective cross-sectional study conducted over a 2-year period, in which all histologically diagnosed cases of malignant ovarian surface epithelial tumors who underwent surgery were included. The fibrotic stroma was classified into three distinct categories - mature, intermediate, and immature. The number of tumor buds was counted at the invasive front of the tumor and graded based on the number of buds - 0-5, 5-9, and ≥10 buds. Results: Among the 50 cases, 32% (16 cases) had mature stroma, whereas 30% (15 cases) and 38% (19 cases) had intermediate and immature stroma, respectively. Although a significant association could not be established between tumor budding and stroma grade, a fair agreement was established between them. A significant association could be established between histological grade with both tumor budding (P = 0.03) and fibrotic stroma grade (P = 0.02). Conclusion: The study highlighted the role of stromal response in malignant surface epithelial tumors of the ovary since a higher-grade tumor was associated with an immature stroma, whereas a lower-grade tumor was associated with a mature stroma.

Tumor-infiltrating lymphocytes in oral cavity squamous cell carcinoma and its association with clinicopathological parameters.

BACKGROUND: Oral squamous cell carcinoma is one of the most common cancers of the head and neck region. Tumor-infiltrating lymphocytes are naturally occurring mononuclear cells that infiltrate the tumor microenvironment. The aim of the present study is the evaluation of stromal tumor-infiltrating lymphocytes (TILs) in oral squamous cell carcinoma and its association with clinicopathological parameters like age, gender, site, tumor stage, nodal status, grade, lymphovascular and perineural invasion. MATERIALS: A total of 51 patients of oral cavity squamous cell carcinomas who underwent resection were included in the study. Assessment of the stromal TILs was done on sections stained with Hematoxylin and eosin using the scoring criteria proposed by the International Immuno-Oncology Biomarker Working Group. TILs were assessed in percentages as continuous scores and subsequently categorized into low TILs (<20%) and high TILs (≥20%). The association between TILs and clinicopathological parameters was evaluated using the Fischer exact/Chi-square test. RESULTS: Among the 51 cases evaluated in the present study, low and high TILs were found in 25.5% and 74.5% of cases respectively. TILs were found to show a significant association with tumor size and lymphovascular invasion. However, no significant association was found with age, gender, nodal status, grade, perineural invasion, and site in the oral cavity. CONCLUSION: The evaluation of TILs as proposed by the International Immuno-Oncology Biomarker Working Group is a simple, inexpensive test. Morphological evaluation of TIL can provide valuable prognostic information in oral cavity squamous cell carcinoma cases and can be incorporated as a part of routine histopathological reporting.

Cytomorphological findings in drug defaulters of tuberculous lymphadenitis.

Objectives: Tuberculosis (TB) is an important health problem specially in the developing countries. Although effective chemotherapy is available, compliance of patient is a major challenge. The aim of this study was to describe cytomorphological features of drug defaulters on lymph node on fine-needle aspiration cytology (FNAC) and compare it with newly diagnosed cases. Material and Methods: A cross-sectional study was done for a period of 18 months, in which all patients having tuberculous lymphadenitis were included after taking detailed history regarding previous anti-TB drug intake. Cytomorphological findings in drug defaulters were evaluated and compared with newly diagnosed cases. Results: There were a total of 150 cases with 120 newly diagnosed and 30 drug defaulters. Splintered epithelioid cell granuloma was seen in 40% of drug defaulters, while it was absent in case of newly diagnosed cases (P < 0.0001). Well-formed epithelioid cell granuloma was most commonly seen in newly diagnosed cases (65.83%) followed by poorly formed granuloma (26.67%). Another significant finding was distribution of eosinophils which were significantly high in case of drug defaulters (56.67%) (P < 0.0001). Conclusion: Cytomorphological findings can help in identification of the drug defaulters on FNAC and thus plan further line of treatment.

Cytological features of ectopic nasal meningioma. Report of a case diagnosed using FNAC.

We describe a case of primary extracranial meningioma of the nasal cavity. FNAC showed loose clusters of epithelioid cells with splayed cytoplasm, focal whorling, and occasional psammoma bodies suggestive of meningioma. This case highlights the importance of FNAC in diagnosing meningioma when encountering similar morphology at a rare location.

Prognostic evaluation of cancer associated fibrosis and tumor budding in colorectal cancer.

Colorectal carcinoma (CRC) is the second most common cancer and third leading cause of cancer-related deaths worldwide. Although the staging system provides a standardized guidance in treatment regimens, the clinical outcome in patients with colon cancer at the same TNM stage may vary dramatically. Thus, for better predictive accuracy, further prognostic and/or predictive markers are required. Patients who underwent curative surgery for colorectal cancer in past 3 years at a tertiary care hospital were retrospectively included in this cohort study to evaluate the prognostic indicators, tumor-stroma ratio (TSR) and tumor budding (TB) on histopathological sections and correlated them with pTNM staging, histopathological grading, tumor size, and lymphovascular and perineural invasion in patients with colo-rectal cancer. TB was strongly associated with advanced stage of the disease along with lympho-vascular and peri-neural invasion and it can be used as an independent adverse prognostic factor. TSR showed a better sensitivity, specificity, PPV and NPV as compared to TB in patients having poorly differentiated adenocarcinoma than those with moderately or well differentiated.

To evaluate eosinophilia (tissue eosinophilia, blood eosinophilia and tissue eosinophilia/blood eosinophilia ratio) in increasing grades/ severity of oral neoplastic lesions.

Oral squamous cell carcinoma (OSCC) is the most common cause of morbidity and mortality in India. Buccal mucosa is the most common site because of tobacco quid. Several parameters for the assessment of OSCC have been studied like lymph node metastasis, tumor stage, grade, and perineural invasion. Tumor-associated tissue eosinophilia is another parameter, on which several studies have been done because of its favorable and unfavorable prognosis. The aim of our study is to study quantitative and qualitative eosinophilia in premalignant and malignant lesions of squamous origin in oral cavity with respect to tumor-associated blood eosinophilia. A retrospective study was done at Tertiary care hospital between January 2016 and December 2016. A total of 150 cases of premalignant (oral leukoplakia and dysplasia) and malignant oral squamous cell carcinoma (of various grades) along with blood pictures were evaluated.

Monkeypox (Mpox) outbreak during COVID-19 pandemic-Past and the future.

Monkeypox infection (Mpox) is caused by the Orthopoxvirus (OPXV) genus of the Poxviridae family, closely resembling its more famous sibling smallpox. Recently World Health Organization (WHO), have renamed monkeypox as Mpox citing racial concerns, so we will be referring to monkeypox as Mpox. There has been a recent outbreak in May 2022 when Mpox cases were identified in all six WHO regions. On July 23, 2022, WHO declared it a public health emergency. Before the current outbreak, Mpox had been reported in people from several parts of central and west African countries; and almost all Mpox cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals. With the waning of smallpox vaccine-induced immunity, Mpox can spread in the global population. Though the virus generally does not cause high mortality in immunocompetent individuals, however, severe disease and mortality may result if the virus spreads to immunocompromised individuals, children, elderly individuals, pregnant women, and individuals living with comorbidities such as diabetes. The current transmission was suspected to have occurred through sexual activity in 95% of the persons with infection. It was found that 98% of the persons with infection were either gay or bisexual men, with 41% suffering from HIV infection. The reasons behind this current epidemiological behavior have to be studied further to formulate a hypothesis that, is it the homosexuals who need to be more concerned or is it a global concern, and is monkeypox changing its behaviour to a sexually transmitted infection? The rash, along with associated lymphadenopathy, is a clue toward Mpox infection, but polymerase chain reaction is needed for the confirmative diagnosis. With the discovery of a vaccine, repurposed antivirals, and precautionary steps to prevent the spread of infection, it might help in the containment of the virus. In addition, what we already know about Mpox has to be re-evaluated, because most of the information gathered is from low-resource settings in Africa. The world at large and health care agencies specifically needs to galvanize a well-funded global plan and research initiatives to contain the spread of Mpox. In this article, we have attempted to make the readers aware of the biology, etiopathogenesis including the changes at the cellular level the virus is causing, the changing trends of the virus transmission, and the clinical manifestations. We have also attempted to elaborate on the potential challenges and the need for early diagnosis and containment of this Mpox outbreak. This could be achieved by effectieve use of vaccination and taking social safety measures, especially by the communities at risk.

Cancer-associated fibroblasts: Is it a key to an intricate lock of tumorigenesis?

The past few decades have witnessed a major leap in knowledge relating to the role of tumor microenvironment (TME) in carcinogenesis and evolving behavior of the tumor. Multiple factors within the TME modulate the cancer cells and the associated therapies. Stephen Paget first asserted that the microenvironment plays an important role in the growth of tumor metastasis. The most important player in the TME is cancer-associated fibroblast (CAF) which significantly participates in the proliferation, invasion, and metastasis of tumor cells. CAFs show phenotypic and functional heterogeneity. Mostly CAFs originate from quiescent resident fibroblast or mesoderm-derived precursor cells (mesenchymal stem cells), although several alternate sources of origin have been noted. However, due to lack of specific fibroblast-restricted markers, it is very difficult to trace lineage and identify the biological origin of distinct subtypes of CAFs. CAFs are predominantly shown by several studies to mainly act as tumor-promoting agents, however, tumor-inhibiting actions are also being validated by several studies. A more objectified and comprehensive functional and phenotypic classification of CAF is required, which will help in better way for tumor management. Here, in this review, we have tried to review the current status of CAF origin, along with phenotypic and functional heterogeneity, and recent progress in CAF research.

Evaluation of Ataxia-Telangiectasia Mutated IVS10 Mutation in Breast Cancer Along with Clinicopathological Parameters.

Background: Breast cancer is the most common cancer in women worldwide, with an estimated 2.26 million new cases diagnosed in 2020. The important genes associated include BRCA1, BRCA2, CHEK2, PTEN, TP53, and ataxia-telangiectasia mutated (ATM). ATM is responsible for repairing double-strand breaks in DNA making it a significant candidate in breast cancer predisposition. ATM variant, c.1066-6T>G, has been associated with an increased risk of breast cancer in some but not all studies. The Indian studies on the allele IVS10-6T>G are very limited. The present study was undertaken to evaluate the associations between c.1066-6T>G ATM gene variant and breast cancer incidence in Indian women and its correlation with histological grade, stage, and surrogate molecular classification. Materials and Methods: Routine histopathological processing was done after adequate fixation of the specimen followed by staining with hematoxylin and eosin and immunohistochemistry for ER, PR, Her2neu, and Ki67. Single-nucleotide polymorphism for ATM allele IVS10-6T>G was studied after DNA extraction, polymerase chain reaction amplification, and restriction enzyme digestion. Results: All cases were found to be negative for ATM allele IVS10-6T>G mutation. Maximum number of patients (19 cases; 52.78%) had pT2 stage tumor followed by 11 patients (30.56%) with pT3. Majority of cases were luminal B (11; 30.56%) followed by triple negative (10; 27.78%). Conclusion: Although the results obtained by mutational analysis in the present study are not in agreement with the previous study on Indian women it agrees with the numerous previous studies and meta-analyses done on women with breast carcinoma in the Western world.

FNAC study of giant cell tumor of tendon sheath (localized tenosynovial giant cell tumor): Clinico-radiological correlation and cytopathological features.

BACKGROUND: Localized tenosynovial giant cell tumor (GCT) or giant cell tumor of tendon sheath (GCTTS), is a benign nodular lesion that arises from the synovium of the tendon sheath of the hands and foot. GCTTS is characterized by the presence of multinucleated giant cells and proliferation of synovial-like mononuclear cells. A clinical diagnosis of GCTTS is kept as a differential when a firm, nodular mass shows decreased signal intensity on both T1-and T2-weighted MR imaging. Treatment is usually marginal excision of the mass. MATERIAL AND METHODS: It is a retrospective study, observed in the past 3 years at a tertiary care hospital. Those cases were included in the study in which histopathological confirmation was available or if clinico-radiological features were confirmatory of the diagnosis of GCTTS when correlated with cytological features. RESULTS: There was a total of 24 cases, out of which 16 were females and 8 males. The tumor was located in the upper limb in 21 cases and in 3 cases the tumor was present in the lower limb. In the upper limb, 18 cases were on the right side and three cases were on the left side. In the lower limb, 1 case was present on the left and 2 on the right side. The cytomorphology consisted of mononuclear stromal cells, multinucleated giant cells, and hemosiderin-laden macrophages in variable numbers. CONCLUSION: It is important to accurately diagnose and categorize giant cell-containing lesions because their prognosis depends on the exact categorization of the tumor.

Application of the international system for reporting serous fluid cytopathology on reporting various body fluids; experience of a tertiary care hospital.

Objectives: Cytological examination of effusion sample is a preliminary and minimally invasive method for the diagnosis of body fluids. Recently, the International System For Reporting Serous Fluid Cytopathology (ISRSFC) and the Indian Academy of Cytologist (IAC) have published guidelines for reporting effusion cytology and calculating the risks of malignancy (ROMs) for each defined category. We report our 2 years of experience in reclassifying and assessing the feasibility of applying ISRFSC and IAC categories to effusion fluid and to provide an estimate of the risk of malignancy for each diagnostic category. Material and Methods: Cytological reports of patients from January 2019 to December 2020 were retrieved and reclassified into a five-tiered classification scheme as per ISRSFC guidelines. Cellblock and immunohistochemistry were performed in selected cases. Clinico radiological and histopathological information were obtained and correlated with the cytological findings wherever available. Results: In the study, 652 cases were included during the 2 years. Out of these, 328 (50.3%) were women and 314 (47.3%) were men. Patient's ages ranged between 2 92 years with a mean age of 47.4 years. There were 366 (56.1%) cases of ascitic fluid followed by 262 (40.1%) cases of pleural fluid and 24 (3.8%) cases of pericardial fluid in the analysis. Of all the cases, 13 (2%) were non-diagnostic (ND), 464 (71.6%) were negative for malignant (NFM) cells, 16 (2.4%) were atypia of uncertain significance, 31 (4.7%) were suspicious of malignancy, and 125 (19.3%) were malignant. Cellblock was prepared in 65 cases. Lung cancer followed by breast cancer was the most common malignancies involving the pleural effusion and ovarian cancer was the most common cause of peritoneal effusion. ROM for each diagnostic category was 23% for ND, 25% for NFM, 56% for the atypical category, 80.6% in suspicious, and 90% were for positive for malignancy category. Conclusion: The use of a five-tiered system as per the ISRFC and IAC guidelines are feasible for the standardized reporting of effusion samples, thus avoiding subjective variation of reporting.

Pleomorphic Liposarcoma of Breast, Presenting as a Recurrent Breast Tumor.

Primary pleomorphic liposarcoma of the breast is a very rare mesenchymal tumor. Sarcoma arising in the breast constitutes <1% of all malignant breast tumors, and liposarcoma of the breast has an incidence of 0.3% of all mammary sarcomas. It is a very aggressive tumor with a high incidence of recurrences and distant metastasis. They can mimic primary invasive breast cancer clinically as well as radiologically. Histology and radiological evaluation of the patient help correctly type and grade this malignancy. On microscopy, the tumor is composed of pleomorphic tumor cells with atypical lipoblast with areas of necrosis and mitosis. We report one such rare case here.

Epithelioid Leiomyosarcoma of the Uterus and the Diagnostic Challenge in Diagnosing it on Small Biopsy.

Epithelioid leiomyosarcoma of the uterus is a rare soft-tissue tumor of the pelvis with <1% cases. It can be asymptomatic or can reach an enormous size, resulting in chronic pelvic pain, postmenopausal bleeding, or may cause bowel and bladder dysfunction. The diagnostic dilemma arises especially when they have epithelioid morphology. This case is being presented because of its rare incidence along with the diagnostic dilemma it presented due to epithelioid morphology which is a very rare presentation, especially challenging on small biopsies. This case also highlights the usefulness of immunohistochemical markers, such as WT1, p53, and p16, which has important diagnostic as well as prognostic values in rare variants of usual tumors. Leiomyosarcoma per se is a highly aggressive tumor, therefore, timely diagnosis and management are advised.

Study of Pulmonary Arterial Hypertension in Patients of Chronic Kidney Disease Stage IV and V.

INTRODUCTION: Pulmonary arterial hypertension (PAH) is an overlooked complication in CKD. PAH may be induced or aggravated by various risk factors found in CKD but the pathogenesis is not fully elucidated. ;Aim: To study the occurrence of PAH in CKD stage 4 and 5 and to study the risk factors for development of PAH in these patients. ;Method: An observational cross-sectional study was conducted on 100 patients of CKD stage 4 and 5 at VMMC and Safdarjung Hospital and all necessary investigations were done. ;Results: Out of 100 CKD patients, PAH was found in 61 patients, of which 23 had mild, 34 had moderate and 4 had severe PAH. Significant association was seen of systolic and diastolic blood pressure with high systolic blood pressure also associated with increased PAH severity. Significant association was seen of haemodialysis, arteriovenous fistula (AVF), CKD severity & haemodialysis duration. Increased hemodialysis duration & AVF were significantly associated with PAH severity also. Anaemia, low calcium, high phosphate, increased calcium phosphate product and increased intact-parathormone were significantly associated with PAH while except calcium, these were also significantly associated with increased PAH severity. Lower LVEF% was also significantly associated with PAH and its severity. None of them was an independent significant risk factor for PAH. ;Conclusion: PAH is an important complication in CKD and its severity increases with deterioration of renal function in CKD. Various risk factors are present and treatment of these can decrease the progress and severity of PAH, thereby decreasing the morbidity and mortality in CKD.

Covid19, beyond just the lungs: A review of multisystemic involvement by Covid19.

With the commencement of the COVID19 pandemic, following its 1st case reported in Wuhan in China, the knowledge about the virus as well as the symptoms produced by the disease have drastically increased to this day. The manifestations of COVID19 is now known to affect multiple organ systems of the body, which have shown to have acute as well as chronic complications. Histopathological analysis of the biopsies from the affected organs have implied a direct cytopathic effect of the virus but at the same time not ruling out other causes like hypoxia metabolic changes etc., occurring during the course of the disease. In this review article, we have highlighted the histopathological changes in various organs as reported by various studies throughout the world for a better understanding of the etiopathogenesis of COVID19.

Sternocleidomastoid tumor of infancy-Importance of cytopathological diagnosis and challenges.

OBJECTIVE: Sternocleidomastoid tumor of infancy (SCMI) is a rare, benign self-limiting condition which occurs in the perinatal period. The goal of our study is to highlight clinicoradiological and cytopathological findings in these cases. MATERIAL AND METHODS: A study was done at a tertiary level hospital, from January 2016 to December 2019. Thirteen cases were studied, out of which 11 were clinically suspected cases of SCMI tumor and two cases were clinically suspected as cervical lymph node tuberculosis which were finally diagnosed as SCMI on fine needle aspiration cytology (FNAC) evaluation. Drs. N. K., S. Z., S. S. K., and S. R. independently reviewed the original diagnosis. Clinical, ultrasonographical, and cytopathological features are highlighted along with follow-up of the cases. RESULTS: There were a total of 13 cases, out of which 11 cases were neonates and two cases were more than 1 month of age (2 months and 2.5 months). Male: female ratio was 10:3 and swelling was present more commonly on the right side of the neck. Ultrasonography predominantly showed non-cystic, bulky, and heterogenous echotexture of the sternocleidomastoid muscle. Smears were moderately cellular showing mainly singly scattered oval to spindle shaped fibroblasts along with degenerating and regenerating muscle fibers. CONCLUSION: FNAC along with adequate clinic-radiological correlation aids in early and reliable diagnosis and can help curtail complications.

Efficacy of Intralesional Platelet-Rich Plasma in Diabetic Foot Ulcer.

BACKGROUND: Diabetic foot ulcer (DFU) is well managed by infection control, euglycemic state, and debridement of the ulcer followed by appropriate dressing and off-loading of the foot. Studies show that approximately 90% of DFUs that are properly off-loaded heal in nearly 6 weeks. Platelet-rich plasma (PRP) serves as a growth factor agonist and has mitogenic and chemotactic properties that help in DFU healing. We sought to evaluate the efficacy of local application of PRP with respect to healing rate and ulcer area reduction in treating DFUs. METHODS: Sixty noninfected patients with DFUs (plantar surface area, ≤20 cm2; Meggitt-Wagner grades 1 and 2) were randomized to receive normal saline dressing (control group [CG]) or PRP dressing (study group [SG]) along with total-contact casting for 6 weeks or until complete ulcer healing, whichever was earlier. Healing rate and change in ulcer area were evaluated weekly. RESULTS: Mean ± SD ulcer area at baseline was 4.96 ± 2.89 cm2 (CG) and 5.22 ± 3.82 cm2 (SG) (P = .77), decreasing to 1.15 ± 1.35 cm2 (CG) and 0.96 ± 1.53 cm2 (SG) (P = .432) at 6 weeks. Mean ± SD percentage reduction in healing area at 6 weeks was 81.72% ± 17.2% (CG) and 85.98% ± 13.42% (SG) (P = .29). Mean ± SD healing rate at 6 weeks was 0.64 ± 0.36 cm2 (CG) and 0.71 ± 0.46 cm2 (SG) (P = .734). CONCLUSIONS: The PRP dressing is no more efficacious than normal saline dressing in the management of DFU in conjunction with total-contact casting.