Analysis of Carcinogenic Heavy Metals in Gallstones and its Role in Gallbladder Carcinogenesis.

PURPOSE: Gallstone is a high-risk factor for gallbladder pre-malignancy or malignancy (GB PM-M) but which substances of gallstones definitely assist to turn out in to GB PM-M, remains unclear. This study aimed to find out the presence of carcinogenic heavy metals in gallstones and to explore the aetiopathogenesis of gallbladder pre-malignancy and malignancy. METHODS: Presence of elements in gallstones was detected by energy dispersive X-ray spectroscopy (EDS) with scanning electron microscopy (SEM) and then level of carcinogenic heavy metals was estimated in gallstones using atomic absorption spectroscopy (AAS). The experiment was carried out in gallstone samples of 46 patients with gallbladder pre-malignant and malignant condition (PM-M group) and 65 sex and age-matched patients with chronic cholecystitis (C-C group). Gallstones were also classified in to three types such as cholesterol stone, mixed stone, and black pigment stone. RESULTS: EDS analysis detected presence of mercury, lead, and cobalt elements in all types of gallstones of both PM-M and C-C groups. AAS analysis revealed significantly higher amount of mercury (p < 0.001), lead (p < 0.0001), cobalt (p < 0.01), and cadmium (p < 0.01) in the gallstones of PM-M than C-C groups. The presence of these heavy metals also varied among stone types of both groups. EDS phase analysis showed 'dense deposits' of these metals in gallstones. CONCLUSIONS: Presence of significantly higher amount of mercury, lead, cobalt, and cadmium in gallstones may play a pivotal role as risk factors in the development of gallbladder malignancy or pre-malignancy. 'Dense deposits' of these metals in the gallstones which is the first observation, may act as crucial doses of carcinogens.

Evaluation of Clinico-Radio-Pathological Features of Tubular Adenoma of Breast: a Study of Ten Cases with Histopathological Differential Diagnosis.

BACKGROUND & OBJECTIVES: Tubular adenomas are rare benign epithelial tumours of breast affecting predominantly females of child bearing age group. Till now, very small number of cases have been reported in the literature. Present study was carried out to evaluate the clinico-pathological features of tubular adenoma cases diagnosed during three years study period along with discussion of possible differential diagnoses. METHODS: Overall, 346 female breast biopsies were diagnosed as benign lesions in three years (2010-2012), of which 10 cases of tubular adenomas were identified. Available clinical, radiological and cytological data of these cases were analysed retrospectively in detail. RESULT: Tubular adenomas were identified from 16 to 48 years of age with a predilection to younger age group (60% within 30 years). Most of the tubular adenomas were small and circumscribed mimicking fibroadenoma in almost all the cases. Diagnosis of tubular adenoma in each case was possible only after histological examination. Pre-operative diagnosis of tubular adenoma was not established by cytological and radiological evaluation in any case. CONCLUSION: Tubular adenomas are clinically indistinguishable from other benign breast neoplasms and it should be considered as potential differential diagnosis during histopathological evaluation of breast biopsies.

Eccrine Porocarcinoma of Scalp: a Rare Case Report.

Eccrine porocarcinoma is a rare malignant adnexal tumor of ductal portion of eccrine sweat gland. It occurs commonly in the lower extremities and rarely in scalp, face, ear, trunk and upper extremities. This survey presents a classic case of eccrine porocarcinoma of scalp in a 58 yr old male patient, presenting as cauliflower like growth over parietal aspect of scalp.

Fine-needle aspiration cytology of chondroid syringoma of fore arm: Report of a rare case.

Chondroid syringoma is a rare benign adnexal tumor of sweat glands with microscopic resemblance to the salivary gland pleomorphic adenoma. Cytology is rarely utilized for preoperative assessment of these slow-growing, small, nodular lesions. Definitive cytological diagnosis is also quite difficult, and majority of the aspirates are evaluated as benign adnexal tumors leading to mandatory histopathological examination for pinpoint diagnosis. Here, we report a case of chondroid syringoma of forearm, which was diagnosed by cytology and also confirmed after histopathological examination. Pinpoint cytological diagnosis can help early formulation of necessary management protocol.

Incidental diagnosis of filariasis in association with carcinoma of gall bladder: Report of a case evidenced on ultrasound-guided fine-needle aspiration cytology with review of the literature.

Lymphatic filariasis is endemic in India and South-East Asia. Detection of microfilaria is infrequently reported during cytological evaluation of various lesions or body cavity fluids. Microfilariae in cytological smears of few benign and malignant neoplasms have also been reported. Here we present a very rare case of presence of microfilariae in a smear from ultrasound guided fine-needle aspiration of gallbladder adenocarcinoma. The present patient is probably the second reported case in the literature harboring occult filariasis in association with gallbladder carcinoma. Though it is a chance finding, cytology can be an effective tool for detection of asymptomatic filariasis helping to pave the way of disease eradication.

Preoperative Diagnosis of Tubular Adenoma of Breast - 10 years of experience.

BACKGROUND: Tubular adenomas are rare benign neoplasms of female breast affecting women, predominantly of child-bearing age group. Definitive diagnosis of this tumor is usually achieved after histopathological study. Clinical, radiological, and even cytological features are often insufficient for accurate diagnosis. AIM: The aim of the present study was planned to analyze clinical and radiological features of histologically confirmed cases of tubular adenoma of breast to find out a clue for accurate preoperative cytological diagnosis. MATERIALS AND METHODS: In our 10-year research program, all histologically confirmed tubular adenoma cases of breast were studied. Clinico-radio-cytological features, if available, were analyzed and tabulated. RESULTS: Thirty-three cases of tubular adenoma of breast were studied. Radiological and cytological assessments are available for 12 and 26 cases, respectively. Tubular adenoma could be diagnosed in only two cases (7.7%) by cytological assessment, but in none by radiological assessment. CONCLUSIONS: Clinico-cyto-radiological assessment could identify the benign nature of the tumors in most cases, but final confirmation was possible only after histopathological study.

Fine-needle aspiration cytology of retroperitoneal lesions: a 5-year experience with an emphasis on cytohistological discrepancy.

BACKGROUND: The retroperitoneal space contains various organs which can be affected by various non-neoplastic and neoplastic pathological processes. A diagnosis of these retroperitoneal lesions is often difficult. Fine-needle aspiration cytology (FNAC) under image guidance is now becoming an effective tool for the initial evaluation of retroperitoneal lesions. OBJECTIVE: The present study was undertaken to evaluate the role of ultrasound-guided FNAC in the diagnosis of retroperitoneal lesions in comparison to histopathology and to assess the probable causes of failure in cases of pitfalls in cytodiagnosis. MATERIALS AND METHODS: During the study period of 5 years, a total of 104 cases of retroperitoneal lesions were aspirated under USG guidance. Seven cases yielded inadequate material, the remaining 97 cases were included in the study group. RESULTS: Out of 97 cases, the kidney was the most common organ aspirated (27 cases; 27.8%). Malignant lesions (68 cases; 70.1%) were much more frequent than benign or non-neoplastic lesions (29 cases; 29.9%). Tuberculosis was the most common non-malignant lesion (14 cases) and renal cell carcinoma was the most frequent malignant lesion encountered (15 cases). In 5 cases (7.9%), the histological diagnosis showed inconsistent results in comparison to cytodiagnosis. CONCLUSION: USG-guided FNAC is a safe, rapid, relatively cheap and fairly accurate procedure for the assessment of retroperitoneal lesions.

Mullerian adenosarcoma of uterus with sarcomatous overgrowth and heterologous component associated with stromal deposit in omentum: a case report and review of the literature.

Background. Mullerian adenosarcoma with sarcomatous overgrowth (MASO) is a very rare variant of uterine sarcomas first described by Clement et al. as early as 1974. The presence of heterologous sarcomatous components is associated with aggressive biological behavior. Case Presentation. This is a case report of a 62-year female (P(2 + 0)) presenting with postmenopausal vaginal bleeding. Her preoperative USG revealed subserosal fibroid with adherent omentum. She underwent abdominal hysterectomy with bilateral oophorectomy. Histopathological diagnosis of resected specimen was Mullerian adenosarcoma with sarcomatous overgrowth and presence of heterologous elements involving body of the uterus. The whole thickness of the myometrium was involved along with the presence of serosal nodules and omental deposits of sarcomatous component. Conclusion. MA is considered as a low-grade malignant tumor, but MASO is a high-grade tumor frequently associated with invasion and metastasis with poor treatment outcome. Because of its rarity, correct identification of these tumors and distinction from other uterine sarcomas are a challenging job and hence its morphological features merits attention.

Clinicopathological study of rhinosporidiosis with special reference to cytodiagnosis.

BACKGROUND: Rhinosporidiosis is a chronic infective disorder caused by Rhinosporidium seeberi. It usually presents as a soft polypoidal pedunculated or sessile mass. Nose and nasopharynx are the commonest sites, followed by conjunctiva, maxillary sinuses, penis, urethra. AIMS: The aim of this study is to present the clinicopathological features of rhinosporidiosis in a large series of cases and to asses the role of cytology in diagnosis. MATERIALS AND METHODS: 63 cases were included in the study group. Diagnosis of rhinosporidiosis was confirmed in all cases by histology with or without cytological evaluation. May-Grünwald-Giemsa and hematoxylin and eosin (H and E) staining was used in all cases, and special stains like periodic acid Schiff and mucicarmine were used in a few cases. Detailed clinical history of all the cases was noted. Routine hematological investigations including ABO blood grouping were done in all possible cases. RESULTS: Evaluation of the clinical data in our series demonstrated male predominance (36 out of 63; 56%). Nose and nasopharynx were the commonest sites involved (74.6%). Routine hematology tests did not show any significant change in most of the cases. However, a significant proportion of the study population (18 out of 41; 44%) had blood group O. Cytodiagnosis attempted in 17 cases out of 63 cases achieved 100% correlation with histology. CONCLUSION: Morphological appearance alone in a few cases failed to give diagnosis of rhinosporidiosis. Cytology can be very helpful in diagnosis in these cases, but histology is the mainstay of diagnosis.

Cytodiagnosis of filariasis from a swelling of arm.

Cytological demonstration of microfilaria and adult worms often helps in diagnosis of asymptomatic filarial cases. But demonstration of microfilaria in cytological smears from upper extremity lesions is seldom reported. We are presenting a 32-year-old female patient with elongated, small subcutaneous swelling in the medial aspect of right lower arm. Aspirates from the lesion demonstrate microfilaria though there is no eosinophilia or microfilaremia on subsequent examination of blood sample. In endemic areas, filariasis should always be considered as a possible diagnosis during cytological assessment of any swelling.

Adrenal myelolipoma with abdominal pain: A rare presentation.

Adrenal myelolipomas are rare benign tumors. Most of the cases are asymptomatic and discovered incidentally. We are reporting a case of myelolipoma involving right adrenal cortex of a 40-year-old woman who presented with abdominal pain. A short review of etiology, clinical features, and differential diagnoses of this neoplasm are also discussed. Radiologic features are often helpful in diagnosis but histology must be done to exclude other fat-containing lesions. Although uncommon, myelolipomas should be considered in differential diagnosis of retroperitoneal lesions.

Role of cytology in diagnosis of soft tissue sarcomas with special reference to false positive cases.

BACKGROUND: Histological diagnosis of soft tissue sarcomas is a difficult job not only for diverse architecture of different variants but also for variability in picture among different parts of a single tumor. Thus, cytodiagnosis of these tumors is one of the most challenging jobs. AIMS: To evaluate the role of fine needle aspiration cytology in diagnosis of soft tissue malignancies and discuss the false-positive cases with particular reference to causes of misdiagnosis and possible ways of correction. MATERIALS AND METHODS: In the present study, we used cytology for categorization of 59 soft tissue malignancies according to predominant cell type and also on the basis of differentiation. RESULTS: Out of 59 cytodiagnosed malignant soft tissue tumors, 36 were classified as high grade and rest as low grade. Spindle cell sarcoma was the commonest diagnosis, followed by pleomorphic variant. Histological correlations were performed in 47 cases showing consistency in 41 cases. Rest six cases with disparity were further discussed to ascertain causes of failures and to chalk out possible plans to evade these pitfalls in future. CONCLUSIONS: Overall our study established the role of cytology in diagnosis of soft tissue sarcomas with good cytohistological correlation rate (87.2%).

Cytodiagnosis of filarial infections from an endemic area.

OBJECTIVE: To throw light on cytologic findings as a possible mode of diagnosis of lymphatic filariasis. STUDY DESIGN: Filariasis has worldwide distribution, but lymphatic filariasis predominantly affects tropical and subtropical regions. Demonstration of microfilaremia, the specific test for diagnosis of lymphatic filariasis, often shows false negative results in endemic areas. The present study, done in an endemic area, showed the presence of microfilariae or adult worms of Wuchereria bancrofti in fine needle aspirates collected from amicrofilariaemic cases. In a few cases the discovery was incidental. A total 4,534 cases undergoing cytologic evaluation were carefully screened for the presence of adult worms or larvae, irrespective of clinical diagnosis. Microfilariae were demonstrated in both clinically suspected cases of filariasis and asymptomatic cases. RESULTS: A total of 1 positive cases were found; in 4 cases the clinical diagnosis was lymphatic filariasis, and 7 cases were asymptomatic. All 11 cases were amicrofilariaemic. CONCLUSION: Various sophisticated investigations are used for diagnosis of lymphatic filariasis without microfilaremia. Fine needle aspiration cytology, being a cheap, simple and easy procedure, may have some role in this field, but further detailed studies are needed before any final claim.