Diagnosis of Infarcted Breast Lesions on FNAC, a Blustering Fool: Short Case Series.

Introduction: Fine-needle aspiration cytology (FNAC) is often used as a screening tool. Cytopathologist should be aware of various mimickers of the malignancy. One of these is infarction of benign breast lesions. Careful examination of cytomorphological features will avoid the misdiagnosis of malignancy in such cases. Material and Methods: Six cases were diagnosed as benign breast lesion for 4 years and 5 months in our newly established tertiary referral center. Histopathology follow-up was available in one case. Results: Of six cases, three cases (50%) were reported as fibroadenoma with infarction, two cases (33%) as benign breast lesion with infarction favor fibroadenoma, and one as breast lesion with infarction favor phyllodes tumor in view of recurrence. Most were in the second or third decade of their life. All cases showed dyscohesive cells with pyknotic nuclei. Monolayered sheets of necrotic cells were seen in the four cases (66%). Viable cells were seen in four cases. Conclusions: FNAC provides a rapid and accurate diagnosis of benign breast lesions with infarction in the hands of experienced pathologists who can help in better patient care. Small-sized uniform pyknotic nuclei of dyscohesive cells and regular nuclear membranes help to differentiate them from inflammatory and malignant lesions.

Association of Micronuclear Frequency with Dysplasia and Cytogenetic Changes (p53 Mutation and p16 Expression) in Oral Potentially Malignant Disorders.

Aims: The present study evaluated the frequency of micronuclei in oral potentially malignant disorders (OPMDs) and their association with the presence of dysplasia on cytology and biopsy as well as their association with p53 mutation and p16 expression. Cytological findings of dysplastic changes in OPMDs were compared to histological diagnoses. Material and Methods: This was a cross-sectional, observational, descriptive study. Scrape smears (n = 74) were collected from lesions in patients with OPMDs. Punch biopsy was collected in patients showing dysplastic changes. Tissue microarray for p53 mutation and p16 expression was performed using paraffin embedded blocks. Cases were classified into grades of dysplasia using both scrape smears and biopsy. Micronuclei frequency was calculated per 100 cells using scrape smears. Mann-Whitney U test was used for correlation of cytology and histology for grade of dysplasia as well as micronuclear frequency with p53 mutation and p16 expression. Results: Micronuclear frequency was found to be increased in patients with dysplasia. A significant association of micronuclear frequency with dysplastic changes was seen on cytology. Sensitivity of cytological evaluation was found to be 64.7%. The association of the micronuclear frequency of samples with p53 mutation and p16 expression was nearly significant (n = 28, P = 0.069 and 0.095, respectively). Conclusion: Micronuclear frequency can be a reliable marker of mutagenic change in OPMDs. Cytological assessment of micronuclei can serve as useful, non-invasive, and relatively inexpensive tool to predict cancerous changes in OPMDs.

Haematology audit of 801 COVID-19 patients' basics and beyond- Prospective observational study.

Background and Objective: COVID-19 has become a major health concern since 2020. Its clinical presentation varies from asymptomatic cases to cases with respiratory failure needing ICU management. It has created a huge burden on limited health care resources. We need better understanding of the pathogenesis and interplay between virus and other factors which decide outcome. We seek biomarkers to predict severe illness to offer better triaging of patients to provide hospital-based care to the patients at risk of severe illness. Material and Methods: We took 801 consecutive RT-PCR-positive COVID cases coming to our center. Their hematological work-up, such as complete blood count, peripheral smear, reticulocyte count, and G6PD activity, was tested. The pattern of hematological abnormalities was assessed across disease severity groups to identify predictors of severe illness from basic investigation. Also, the interplay between iron deficiency and possible hemoglobinopathy trait and COVID was explored. Results Discussion and Conclusion: We found old age, male gender, diabetes, neutrophilia, lymphopenia, monocytopenia, and eosinopenia at presentation to be associated with moderate to severe illness and may help in triaging with other inflammatory and radiological parameters. We found thrombocytosis rather than thrombocytopenia as a predictor of severe illness. Our preliminary findings suggest the need to explore the protective role of hemoglobinopathy traits and iron deficiency against severe COVID illness.

Cervical Cancers: Varieties and the Lower Anogenital Squamous Terminology.

Carcinoma of cervix is classified as per the WHO classification into primary tumors which are predominantly epithelial tumors, mesenchymal tumors and tumor like lesions, mixed epithelial stromal tumors, melanocytic, germ cell, and lymphoid tumors. Secondary tumors are uncommon. Squamous cell carcinoma (SCC) in various morphological forms needs to be separated from other epithelial tumors for treatment modality selection. Majority of SCC are human papilloma virus (HPV) positive. The histological pattern, HPV type, and grading do not affect prognosis. Mixed mesenchymal and epithelial tumors are of Mullerian origin. Among sarcomas, Botryoid rhabdomyosarcoma needs to be looked for, as a small biopsy may miss it. Carcinoma cervix is not the only cancer caused by HPV. High-risk HPV is implicated in causation of various other cancers such as anal cancers, oropharyngeal cancers, vulval cancers, vaginal cancers, and penile cancers. Low-risk HPV viruses similarly cause infections of perianal and genital region in males and females. The terminology for these lesions has evolved before understanding of pathogenesis of low- and high-risk HPV. The lower anogenital squamous terminology (LAST), an acronym for LAST, incorporates the low- and high-grade squamous intraepithelial lesion (HSIL) terminology. In invasive cancers, a superficially invasive SCC is a well-defined entity. LAST outlines areas where p16 use is recommended. No benefit of addition of other biomarkers like p63 or ki67 is found in problem-solving in differentiation of HSIL from mimics or low-grade squamous intraepithelial lesion. Routine use of biomarkers is not advocated.

Association of COVID-19 Real-Time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Cycle Threshold Value With Surrogate Markers of Disease Severity.

Introduction The cycle threshold (Ct) value in real-time reverse transcription-polymerase chain reaction (RT-PCR) serves as a criterion to diagnose coronavirus disease 2019 (COVID-19) and is inversely proportional to viral load. Levels of inflammatory markers such as aspartate aminotransferase (AST), ferritin, D-dimer, high sensitivity C-reactive protein (hs-CRP), and lactate dehydrogenase (LDH) are used as quantitative measures of COVID-19 severity. We examined the association between these markers and Ct values. Methodology This retrospective data analysis included 400 patients with positive RT-PCR results for COVID-19 who were admitted to a tertiary care hospital. Clinical and biochemical data were accessed from the hospital information management system. Associations of clinical parameters and markers of disease severity (e.g., polymorph, AST, hs-CRP, D-dimer, LDH, and ferritin levels) with Ct values were assessed. Observations LDH, ferritin, D-dimer, and hs-CRP were found to be significantly higher in moderate and severe groups than in the mild COVID-19 group. AST, ferritin, and hs-CRP levels were also significantly higher in severe COVID-19 subjects, compared to moderate COVID-19 subjects. Ct values for the E (envelop) gene and ORF (open reading frame) 1b gene were found to be significantly higher in those with severe COVID-19. Polymorph counts in subjects with Ct values of 25 or higher were significantly increased, compared to those with Ct values under 30. LDH, D-dimer, and hs-CRP levels in subjects with Ct values over 30 were significantly lower than for those with Ct values under 30. Ferritin was the best independent predictor of non-survival in study subjects, with an area under the curve (AUC) of 85.5% (95% confidence interval = 73.2-95.9). The Ct value for the E gene had an AUC of 75.1%, and the ORF1b gene had an AUC of 64.5%. However, no significant correlation was detected between any parameter and Ct value. Conclusion Polymorph, LDH, ferritin, D-dimer, and hs-CRP levels were significantly elevated in subjects with low E gene Ct values. Also, these subjects were at risk of severe disease and fatality. Ct values for the E gene thus could serve as an early indicator for patients at risk of severe disease and death.

Tracing, Tracking and Treating COVID-19 Associated Rhino-Orbito Cerebral Mucormycosis (ROCM).

Surge in the number of mucormycosis cases following second wave of coronavirus disease-19 (COVID-19) infection posed several diagnostic and prognostic challenges. This study was aimed to describe clinical, diagnostic features and survival outcomes among patients of mucormycosis in post COVID-19 context. Retrospective chart review. This study included 44 COVID-19 positive screened cases who presented with clinical features suggestive of mucormycosis. Demography, clinical profile, diagnostic findings, and the treatment outcome are studied. Medical and surgical outcomes are summarised as frequencies and percentages. The reliability of microbiological, and radiological findings against the pathological findings was analyzed using Kappa statistics (k). Based on constellation of microbiological, pathological and radiological findings 28 cases (63%) confirmed with mucormycosis infection. The mean (SD) age was 54.9 (12.9) years and two-third were males. The majority (90%) of cases presented with the feature of facial swelling, headache nasal blockade. Inpatient care for treatment of COVID-19 was recorded in 33 (75%). Diabetes mellitus was the commonest comorbidity in 27 (61.4%), 38 (86.4%) cases were treated by steroids and 30 (68.2%) were given oxygen therapy. There is a strong agreement (k = 0.83) between pathological and microbiological investigations. In thirty-eight cases (86.3%) remission was achieved when assessed after 8 weeks. Of the 44 cases, four patients died. The results of the current study suggest that the disease residues and/or recurrences in critical areas are frequent in mucormycosis. However, using the strategy of screening at risk patients, diagnosing, treating them with combination of antifungals, surgical debridement, and timely follow up may help in improving outcomes as compared to pre COVID-19 era.

Evaluation of Role of Intraoperative Cytology Technique in Diagnosis and Management of Cancer.

CONTEXT: Intraoperative pathological assessment provides valuable information in a patient's diagnosis and management. Touch imprint/crush cytology is simple, rapid, and cost-effective. Also, imprint smears give excellent cytomorphology. AIMS: To assess the utility and feasibility of intraoperative cytology technique as a rapid and reliable method for diagnosis and to compare sensitivity, specificity and diagnostic accuracy with histopathology. MATERIALS AND METHODS: Cytology smears were collected intraoperatively from 52 cases of suspected/proven malignancy. From tumors, surgical margins, lymph nodes; crush, imprint, and scrape smears were prepared. Smears were taken from specimens before formalin fixation and stained with rapid ultrafast Papanicolaou stain. The slides were compared with the histopathology report which is the gold standard. STATISTICAL ANALYSIS: Sensitivity, specificity, and diagnostic accuracy were used for statistical analysis. RESULTS: Intraoperative cytology report could be given in time for the surgeon to modify margins of resection and the extent of lymph node dissection. It helps the surgeon to modify surgery. The diagnostic test evaluation showed satisfactory results. CONCLUSION: Intraoperative imprint/crush cytology is a simple, inexpensive, rapid, accurate cytodiagnostic technique in the diagnosis of cancer where frozen section facilities are not available. It can also be used to assess the clearance of surgical margins.

Utility of papanicolaou stain-induced fluorescence in the cytodiagnosis of extrapulmonary tuberculosis.

OBJECTIVE: To study the utility of Papanicolaou stain-induced fluorescence (PIF) in the detection of tubercle bacilli and to compare its diagnostic efficacy with that of the conventional Ziehl-Neelsen (ZN) method. STUDY DESIGN: This prospective study was carried out at a tertiary health care center, over a period of 2 years between January 2001 and December 2002. A total of 500 cases offine needle aspiration cytology from lymph nodes and other extrapulmonary sites were studied. Only cases that were clinically and cytologically suggestive of tuberculosis were included in the study. The smears were stained with ZN and Papanicolaou stain and examined under light and fluorescence microscopes, respectively for detection of acid-fast bacilli (AFB). Mycobacterial culture was used as the gold standard to compare the results. RESULTS: Cytologic smears were categorized into 4 distinct cytomorphologic patterns: epithelioid granulomas without caseous necrosis (101 cases), epithelioid granulomas with caseous necrosis (268 cases), caseation or acute inflammatory exudate only (114 cases), and occasional epithelioid cells without necrosis or giant cells (17 cases). The overall AFB positivity was 30.8% with the ZN method, while it was 40.6% with PIF. Moreover, PIF was more effective in detecting bacilli in group I lesions (18.8% vs. 6.9% with ZN method), in which the bacillary load is very low. CONCLUSION: PIF is superior to the conventional ZN method in detecting tubercle bacilli, particularly when the bacillary load is low. It is a relatively inexpensive and fast technique.

Comparative study of manual liquid-based cytology (MLBC) technique and direct smear technique (conventional) on fine-needle cytology/fine-needle aspiration cytology samples.

BACKGROUND: Liquid-based cytology technique enables cells to be suspended in a liquid medium and spread in a monolayer, making better morphological assessment. Automated techniques have been widely used, but limited due to cost and availability. AIM: The aim was to establish manual liquid-based cytology (MLBC) technique on fine-needle aspiration cytology (FNAC) material and compare its results with conventional technique. MATERIALS AND METHODS: In this study, we examined cells trapped in needles hub used for the collection of FNAC samples. 50 cases were examined by the MLBC technique and compared with the conventional FNAC technique. By centrifugation, sediment was obtained and imprint was taken on defined area. Papanicolaou (Pap) and May-Grünwald Giemsa (MGG) staining was done. Direct smears and MLBC smears were compared for cellularity, background, cellular preservation, and nuclear preservation. Slides were diagnosed independently by two cytologists with more than 5 years' experience. Standard error of proportion was used for statistical analysis. RESULTS: Cellularity was low in MLBC as compared with conventional smears, which is expected as remnant material in the needle hub was used. Nuclei overlap to a lesser extent and hemorrhage and necrosis was reduced, so cell morphology can be better studied in the MLBC technique. P value obtained was <0.05. CONCLUSION: This MLBC technique gives results comparable to the conventional technique with better morphology. In a set up where aspirators are learners, this technique will ensure adequacy due to remnant in needle hub getting processed.