Carcinomatous meningitis mimicking Creutzfeldt-Jakob disease.

We report a case of carcinomatous meningitis diagnosed at autopsy that was clinically diagnosed as a case of Creutzfeldt-Jakob disease (CJD) because of rapidly evolving dementia. Pathological study revealed diffusely spreading carcinomatous meningitis, infiltrating into cortex along Virchow Robin space. Immunostaining for Prion protein was negative. Despite advances in clinical diagnosis, tissue diagnosis remains a pre-requisite for confirmation of CJD.

Malignant phyllodes tumor metastatic to the forearm: a case report.

We describe the cytological features of a malignant phyllodes tumor, in a 40-yr-old female, that metastasized to the forearm, and we correlate these findings with the criteria suggested by other authors for predicting the clinical and metastatic behavior of this tumor. The diagnosis of metastasis was based on fine-needle aspiration (FNA) cytology. One year prior, the patient had undergone mastectomy of the left breast for malignant phyllodes tumor, as proven by histopathology. The patient then presented with right forearm swelling, 1 yr later. FNA cytology was performed, and the diagnosis was metastatic malignant phyllodes tumor. Histologic review of the breast tumor revealed stromal overgrowth, which is the most important histologic criterion for predicting the metastatic behavior of malignant phyllodes tumor as reported by some authors.

Significance of histopathological classification in leprosy.

A retrospective blind study was carried out on 2640 patients of leprosy to correlate the histopathological and clinical classification of leprosy using the criteria laid down by Ridley and Jopling. There was complete agreement between histopathological and clinical classification in 81.8% of the cases, with one step deviation in 5.1% of the cases. Histopathological diagnosis of indeterminate leprosy in high percentage (15.9%) as against 3.3% of indeterminate leprosy clinically in our series was an interesting feature. Type-wise correlation between histopathological with clinical classification was very high, it being the highest in LL (98%) followed by TT (97%), BT, BB and BL (95%, 89% and 87% respectively).

Fine needle aspiration biopsy of breast lesions and histopathologic correlation. An analysis of 837 cases in four years.

OBJECTIVE: To correlate fine needle aspiration biopsy (FNAB) and histopathology in 837 cases. STUDY DESIGN: A study consisting of 837 FNABs of breast lesions and their histopathologic correlation was conducted at Goa Medical College Hospital, Bambolin, Goa, India, over a period of four years, from January 1987 to December 1990. Six hundred cases were followed with excision biopsy/mastectomy, and a cytohistologic correlation was established. The diagnostic accuracy of this series was assessed and compared with data obtained from the Indian and international literature. RESULTS: The diagnostic accuracy of this series (sensitivity 93.80%, specificity 98.21%, predictive value of a positive result 92.70%, efficiency 97.40%) was compared with that in published reports. Statistically significant differences were found between the levels of diagnostic accuracy in series published by pathologists who diagnosed smears prepared by clinicians and surgeons (group A) and series published by pathologists who performed palpation and aspiration and made the cytologic diagnosis themselves (group B). These differences consisted mainly of a lower number of false positives and unsatisfactory samples in group B. CONCLUSION: Fine needle aspiration biopsy is an effective modality for the diagnosis of breast lesions. Lower rates of false positive and false negative diagnosis are achieved if the cytopathologist has personally performed the FNAB, prepared the smears and performed the microscopic interpretation. The diagnostic accuracy achieved with direct smear preparation is as good as that obtained by the newer Cytospin method for FNAB.

Role of fine needle aspiration cytology as the initial modality in the investigation of thyroid lesions.

OBJECTIVE: To study the utility of fine needle aspiration (FNA) cytology as the initial modality in the investigation of thyroid lesions. STUDY DESIGN: Fine needle aspiration biopsies performed on patients presenting with diffuse or nodular thyroid enlargement and solitary thyroid nodules at the Goa Medical College Hospitals, Bambolim Goa, India, from January 1986 to June 1993, were reviewed. Two thousand four biopsies were performed on 1,992 patients, with 12 patients undergoing repeat FNA biopsy at different times due to an inconclusive primary result. These repeat biopsies were also inconclusive and were excluded from the series, leaving 1,992 cases. Two hundred thirty-eight of these 1,992 cases underwent surgery, either excision of the nodule or some form of thyroidectomy for a cytologically suspicious diagnosis, compression symptoms or cosmetic reasons, and a cytohistopathologic correlation was established in these cases. Twenty-five of the 238 cases that had inadequate cytologic findings were excluded, and the accuracy was studied in the remaining 213 cases. RESULTS: The results of FNA classified 1,557 (78.16%) of these cases as benign, 151 (7.58%) as suspicious, 30 (1.51%) as malignant and 254 (12.75%) as unsatisfactory. Cytohistopathologic correlation was established in 238 cases, which were operated on. Nine (5.5%) of 163 cases with an FNA diagnosis of benign, 10 (26.3%) of 38 cases with an FNA diagnosis of suspicious and 11 (91.67%) of 12 cases with an FNA diagnosis of malignant were histologically malignant. CONCLUSION: FNA biopsy of the thyroid can be used effectively as the initial modality in the evaluation of thyroid lesions, both nodular and diffuse. It is very useful in detecting neoplastic foci in multinodular goiter and also in evaluating solitary thyroid nodules.

Sister Mary Joseph's nodule--diagnosis of umbilical metastases by fine needle aspiration.

A 40 year old male patient presented with jaundice. The patient had a small periumbilical nodule. He was referred to the department of Pathology for FNAC of the nodule. A diagnosis of metastases from adenocarcinoma was made. Further investigations revealed carcinoma of stomach with metastatic deposits in liver. The present report highlights the utility of F N A C in diagnosis and to decide on further investigations to arrive at a final diagnosis in a given case. A brief review of historical aspect is also given.

Treatment of Reiter's disease.

Two classical cases of Reiter's disease, one successfully treated with methotrexate and the other with sulphasalazine are reported.