Cytodiagnosis of papillary carcinoma of the breast: Report of a case with histological correlation.

Papillary lesions of the breast pose diagnostic challenges on aspiration cytology due to overlapping features of benign and malignant entities. Accurate cytologic diagnosis of papillary breast carcinoma cannot usually be made pre-operatively. We present the case of an adult female who underwent fine-needle aspiration (FNA) of a left breast lump. FNA smears were highly cellular showing cohesive clusters, complex papillary fragments and few singly dispersed intact cells. The tumor cells had hyperchromatic nuclei, prominent nucleoli and mild nuclear pleomorphism. A cytologic impression of papillary lesion, possibly malignant (in view of high cellularity, complex papillae and single intact cells) was rendered. The lesion proved to be a papillary carcinoma with microscopic foci of stromal invasion on histologic examination. Papillary carcinoma, an uncommon subtype of breast carcinoma, should be considered while evaluating a papillary lesion with complex branching papillae containing delicate fibrovascular cores and singly lying intact atypical cells.

Histopathological correlation of atypical (c3) and suspicious (c4) categories in fine needle aspiration cytology of the breast.

Introduction. According to the National Cancer Institute (NCI) guidelines in 1996, breast lesions are categorized as C1 to C5 on fine needle aspiration (FNA) cytology. Very few studies are available in the English literature analyzing histopathology outcome of C3 (atypical, probably benign) and C4 (suspicious, probably malignant) lesions. Our study aims to correlate FNA cytology of breast lump diagnosed as C3 and C4 lesion with histopathological examination. Methods. During a period of 2 years, 59 cases of C3 and 26 cases of C4 were retrieved from total 1093 cases of breast FNA. All the cases were reviewed by two cytopathologists independently. The final 24 cases of C3 and 16 cases of C4 categories were correlated with histopathological diagnosis. Result. Among C3 category, 37.5% revealed malignant findings, whereas of C4 category, 87.5% were malignant on histopathology. This difference was statistically significant (P = 0.0017). Sensitivity, specificity, positive predictive values, and negative predictive value of C4 category in diagnosing breast malignancy were 60.8%, 88.2%, 87.5%, and 62.5%, respectively. Conclusion. Although FNAC is simple, safe, cost-effective and accurate method for diagnosis of breast masses, one must be aware of its limitations particularly in C3 and C4 categories. Also, since both these categories carry different probabilities of malignancy and thus different management, we therefore, support maintaining C3 and C4 categories.

A rare case of Endometriosis in vaginal hysterectomy scar.

Presented hereunder is probably the first reported case of endometriosis at the vaginal apex following vaginal hysterectomy. No other similar case could be traced in the review of the literature.

Angiogenesis in Non-Hodgkin's Lymphoma: An Intercategory Comparison of Microvessel Density.

Background. This study was aimed at comparing angiogenesis, seen as microvessel density (MVD) in subtypes of non-Hodgkin's lymphoma (NHL). Methods. In this study, 64 cases of NHL diagnosed over a three-year period were included along with 15 lymph node biopsies of reactive hyperplasia. NHLs were classified using REAL classification, and immunohistochemistry was performed for CD34 in all cases. CD34-stained sections were evaluated for "hot spots," where MVD was assessed and expressed as per mm(2). Appropriate statistical methods were applied. Results. There were 6 cases of well-differentiated lymphocytic lymphoma (SLL), 21 diffuse large B-cell lymphoma (DLBCL), 15 follicular lymphoma, 10 lymphoblastic lymphoma, 7 MALToma, and 5 peripheral T-cell lymphoma (PTCL). Mean MVD was highest in reactive hyperplasia (191.92 ± 12.16 per mm(2)) compared to all NHLs. Among NHLs, PTCL demonstrated the highest MVD (183.42 ± 8.24) followed by DLBCL (149.91 ± 13.68). A significant difference was found in MVD between reactive and individual lymphoma groups. SLL had significantly lower MVD than other lymphoma subtypes. Conclusion. Angiogenesis, assessed by MVD, showed significant differences among subtypes of NHL, especially the indolent types like SLL. The higher MVD in aggressive lymphomas like PTCL and DLBCL can potentially be utilized in targeted therapy with antiangiogenic drugs.

Comparison of working formulation and REAL classification of non-Hodgkin's lymphoma: an analysis of 52 cases.

BACKGROUND: Several classification systems have been proposed for non-Hodgkin's lymphoma (NHL), of which Working Formulation (WF) and the recent Revised European American Lymphoma (REAL) classification are the two most widely used. There have been only a few studies comparing the two classification systems. The present study was undertaken in view of the paucity of literature comparing the foresaid classifications. METHODS: This retrospective and prospective study included 52 cases of NHL. These cases were examined thoroughly with the routine stains and immunohistochemistry using a panel comprising CD45, CD20, CD45RO, CD5, and CD30. All the cases were classified using the WF as well as the REAL classification, taking into account the immunohistochemical results. RESULTS: A wide age range and a slight male predominance were noted. The majority of cases were nodal, while 17% were extranodal. Using the WF, intermediate grade was the most common (65·38%), of which malignant lymphoma, diffuse large cell type and diffuse mixed small and large cell type were the two most frequent categories. On immunohistochemistry, 76·9% of the cases were B-cell immunophenotype. Of the various B-cell lymphomas, the most common was follicle center lymphoma and most common T-cell lymphoma was peripheral T-cell lymphoma. A comparison of the two classification systems revealed that T-cell neoplasms were grouped with B-cell lymphomas in the WF. CONCLUSION: Though REAL classification requires a detailed immunohistochemical panel for thorough classification of all cases, the use of a basic panel of B- and T-cell markers allows the distinction between B- and T-cell lymphomas. Hence, REAL classification should be employed for categorization of NHL even in smaller centers with limited immunohistochemical panel.