Ectopic Intrathymic Parathyroid adenoma demonstrated on Tc-99m Sestamibi SPECT-CT.

Intrathymic parathyroid adenoma is a rare cause of primary hyperparathyroidism. In this case, Tc-99m Sestamibi SPECT-CT successfully localized abnormal tracer uptake in the mediastinum with corresponding low density lesion on CT images suggestive of mediastinal parathyroid adenoma which late on confirmed on histopathology. After the median sternotomy a large intrathymic parathyroid adenoma was identified and excised. With the help of gamma probe the surgeons detect the lesion early and with more confidence as well as reducing the total operation time. Tc-99m Sestamibi SPECT-CT scintigraphy and gamma probe localization is recommended for preoperative and intra operative localization of ectopic parathyroid adenomas.

Nuchal Fibroma : A rare entity of neck masses.

A nuchal fibroma is a rare benign mass; it is a fibrolipoma-like soft tissue mass, usually located in the lower back and the neck. Males are affected far more often than females. It can occur extranuchally. It is a slow growing tumor and usually asymptomatic. We present a rare case of a 39-year old female who was diagnosed with nuchal-type fibroma on final pathology. The proper management for this type of tumor is complete excision.

Role of fine needle aspiration cytology in nodular sclerosis variant of Hodgkin's lymphoma.

OBJECTIVE: To assess the efficacy of fine needle aspiration cytology (FNAC) in the diagnosis of nodular sclerosis variant of Hodgkin's lymphoma (NSHL) and to analyze cytologic features that could help in subtyping a case of Hodgkin's lymphoma into this variant. STUDY DESIGN: FNAC smears of 18 histopathologically proven cases of NSHL were analyzed for a variety of features. RESULTS: On initial cytologic assessment, 14 of 18 cases were diagnosed as Hodgkin's lymphoma. No further subtyping was performed. In this retrospective analysis it was possible to revise the diagnosis in the remaining 4 cases. Of the various cytologic features analyzed, presence of numerous lacunar-type cells along with fibroblasts and collagenous material were useful pointers toward a diagnosis of nodular sclerosis variant. Fibroblasts were seen in 83.33%, collagenous material in 27.77% and numerous lacunar cells in 77.77%. CONCLUSION: Subtyping of NSHL based on cytologic features alone has been a matter of debate for a long time. Of the various subtypes, nodular sclerosis poses the greatest diagnostic difficulty. Though certain cytologic features may help in suggesting a diagnosis of nodular sclerosis variant, the primary role of fine needle aspiration is to diagnose a case of Hodgkin's lymphoma as such and advise histopathologic examination for further categorization.

Fine needle aspiration cytology of the thyroid: a cytohistologic study with evaluation of discordant cases.

OBJECTIVE: To analyze the diagnostic efficacy of fine needle aspiration cytology (FNAC) in the initial evaluation of thyroid nodules, with special emphasis on discrepant cytologic diagnoses. STUDY DESIGN: A total of 192 thyroid fine needle aspirates with subsequent histopathologic follow-up were analyzed. The cytologic diagnoses were divided into 4 categories: positive for malignancy, negative for malignancy, indeterminate for diagnosis and nondiagnostic. The detailed cytologic features were studied along with histopathology sections in all these cases by 2 observers (S.J. and P.D) independently. RESULTS: Cytohistologic correlation was seen in 78.1% of cases and discordance in 21.9%. Indeterminate diagnoses accounted for 15.1% of cases. The majority of these were "follicular neoplasms." The overall sensitivity was 84.44% and specificity 99.11 %. A false positive diagnosis was made in 1 case (0.5%), proven a follicular adenoma on histopathologic examination. A false negative diagnosis was seen in 3.6% of cases. These were cases of papillary microcarcinoma. CONCLUSION: FNAC is a safe, sensitive and specific technique in the initial evaluation of thyroid nodules. A correct cytologic diagnosis can be achieved in a majority of cases, thus obviating the need for a second surgical intervention. A careful and diligent search for various cytologic features and accurate sampling can help in reducing the number of indeterminate, false positive and false negative diagnoses.

Follicular variant of papillary thyroid carcinoma -- a cytological study.

The cytological diagnosis of classical papillary carcinoma is easily established based on the characteristic architectural and nuclear features. However, the follicular variant of papillary thyroid carcinoma(FVPTC) poses a diagnostic challenge. In this study we analysed the cytological features of 14 histopathologically proven cases of FVPTC. We inferred that a combination of architectural features such as follicles and syncytial clusters and nuclear features, viz grooves, pseudoinclusions and enlarged nuclei with fine chromatin, were helpful in establishing the diagnosis. It is hence suggested that based on the combination of the aforesaid features a diagnosis of FVPTC be offered whenever it is possible. This helps in patient management, obviating the need for a second surgical intervention.

Clinicopathological features of extranodal lymphomas: Kuwait experience.

A total of 935 patients with extranodal non-Hodgkin lymphoma (NHL) diagnosed in the period between January 1985 and December 2000 in Kuwait Cancer Center, serving the whole population of Kuwait, were used to describe the clinicopathological and epidemiological features of extranodal lymphomas in Kuwait. Extranodal lymphomas accounted for 45% of all NHL observed during this time. All NHL cases from Kuwait Cancer registry were analyzed and pathologically reclassified using the latest WHO (2000) classification. The most common lymphoma observed was diffuse large B-cell lymphoma (58.60%) followed by Burkitt s lymphoma (BL) (3.80%). In the pediatric group, BL comprises more than two thirds of all patients (77.20%). The most common extranodal sites were stomach (19.70%) and skin (17.80%) in the adult group, large intestine (29.80%) and small intestine (19.30%) in the pediatric age group. The majority (73.40%) of adult extranodal lymphomas was in stage IE-IIE and had a very good prognosis. On the contrary, the majority of pediatric extranodal lymphomas were found to be in stage III and IV. Variations in treatment policies (single agent or combined chemotherapy, radiotherapy, combined modality treatment) adopted and changed during the time period of 16 years of this retrospective study were documented.

Fine-needle aspiration in the management of peripheral lymphadenopathy in a developing country.

Fine-needle aspiration (FNA) is a simple, cheap, and well-tolerated procedure that is well-established as a method of definitive diagnosis of palpable masses. This review reports the role of FNA in the investigation of peripheral lymphadenopathy as an alternative to expensive surgical excision biopsy in developing countries, where there are limited funds and facilities. All lymph node aspirates done in the FNA clinic at the Department of Pathology, University College Hospital, Ibadan, between 1995-1997 were reviewed. The aspirates were obtained using 21- or 22-gauge needle with a 5- or 10-ml disposable plastic syringe, smeared on standard microscopic slides and stained with Giemsa and/or Papanicolou stains. The most common diagnosis was reactive change/nonspecific inflammation, constituting 33.4%; tuberculosis and metastatic lesions made up 25. 7% and 22.4%, respectively, while lymphoma constituted 16.9% of cases. The commonly aspirated nodes were cervical. Tuberculosis was the most frequent diagnosis in these nodes and was the most commonly diagnosed infective condition, particularly in those under age 20 years. The sensitivity and specificity of lymph node FNA in the diagnosis of tuberculosis were 79.5% and 100%, respectively. The overall accuracy rate of lymph node aspiration was 89.5%. Our study showed that FNA is a simple, cost-effective procedure which offers a reliable method of diagnosis in distinguishing reactive lymphadenopathy, tuberculosis, and malignant conditions. Diagn. Cytopathol. 1999;21:159-162.