Dysplastic megakaryocytes and eosinophilic precursors in the diagnosis of myeloid sarcoma on lymph node fine-needle aspiration cytology: a case series.

OBJECTIVE: To analyze the cases diagnosed as myeloid sarcoma on fine-needle aspiration cytology (FNAC) of lymph nodes. STUDY DESIGN: Ten cases of lymph node aspirate diagnosed as myeloid sarcoma were analyzed. FNAC was performed as a routine outpatient procedure in all cases. Correlation with peripheral smear, bone marrow examination, flow cytometry and cytogenetics was done wherever possible. RESULTS: Diagnosis of a hematologic malignancy, before fine-needle aspiration, was available in only 2 cases. All 10 cases showed eosinophilic precursors while five aspirates showed megakaryocytes with dysplastic forms. Of the 10 cases, 3 were diagnosed as acute myeloid leukemia, 3 as chronic myeloid leukemia, 1 case as juvenile myelomonocytic leukemia, 1 case proved to be precursor T acute lymphoblastic leukemia/lymphoma and 2 patients did not show blasts on peripheral blood smear but showed blasts, dysplastic megakaryocytes and eosinophilic precursors in the aspirate. CONCLUSION: Thorough workup to search for an underlying hematological malignancy should be done whenever dysplastic megakaryocytes and/or eosinophilic precursors are seen in lymph node aspirate.

Papanicolaou society of cytopathology system for reporting pancreaticobiliary cytology: Risk stratification and cytology scope - 2.5-year study.

Objectives: Diagnosis of pancreatic lesions remains a clinical challenge. Early and accurate diagnosis is extremely important for improving the therapeutic usefulness of pancreatic cancers and Endoscopic ultrasonography - fine needle aspiration (EUS-FNA) cytology has come up with this advantage. For current study the authors evaluated the diagnostic accuracy of EUS-FNAC by applying PSC system for reporting pancreaticobiliary cytology and Calculated the malignancy risk associated with the diagnostic categories. Material and Methods: A retrospective study over the period of 2.5 years (April 2017 to Oct 2019) 60 patients in our cohort EUS-FNAC guided unstained fixed and unfixed slides received of pancreatic lesion and were stained with Papanicolau and Giemsa using standard technique and immunocytochemistry, where required Application of Papanicolaou Society of Cytopathology system for reporting pancreaticobiliary cytology Histopathological and clinical follow-up were retrieved. Results: Our study has comparable results with sensitivity, specificity, PPV, and NPV of 92.8%, 100%, 100%, and 92.59%, respectively. Fuurthermore, a diagnostic accuracy of 96.2%. Risk of malignancy is lower for benign and indeterminate category whereas it is higher for suspicious and malignant categories. Conclusion: The application of the new proposed terminology for pancreaticobiliary cytology brings standardization. Final diagnosis can be reached by the multidisciplinary approach of EUS-FNA cytology, cell block preparation, immunocytochemistry, and immunohistochemistry; if required, can be adopted as an alternative approach to biopsy. The present study showed high sensitivity and specificity for EUS-FNA in the diagnosis of pancreatic carcinoma, which may influence the treatment plans of both surgeons and oncologists.

Key cytological findings in FNA from infantile digital fibromatosis.

BACKGROUND: Infantile digital fibromatosis (IDF) or inclusion body fibromatosis is a benign proliferation of fibroblastic and myofibroblastic cells. Its most common site is the digits of young children and it is named for the intracytoplasmic inclusions that are detected in lesional cells. CASE: A two and a half-year-old male child presented with a single flesh-colored nodule on the dorsal aspect of his right little toe since the sixth month of life. FNAC from the lesion showed characteristic cytomorphological features of IDF. CONCLUSION: IDF is a rare lesion occurring in children or infants. There are many case reports describing histopathological features of IDF. To our knowledge, the typical inclusion bodies as cytomorphological findings in IDF have not been described in the literature. This is a rare case diagnosed on cytology and confirmed on histopathology.

Histomorphological analysis of gastric polyps.

INTRODUCTION: Incidence of gastric carcinoma and gastric polyps is on rise all over the world. Chronic atrophic gastritis to intestinal metaplasia progressing to adenocarcinoma has been documented pathway for gastric carcinogenesis. Another pathway for gastric carcinoma is adenoma carcinoma sequence similar to colon cancer. AIM: To study prevalence, endoscopic, and histomorphological features of gastric polyps. METHODS AND MATERIAL: This was retrospective analysis of gastric polyps from 2012 to 2019 in consecutive 10,800 upper gastrointestinal endoscopies. Demographic, endoscopic, and histopathological data were obtained from hospital records. All gastric polyps were classified as per standard histologic criteria. Additional histological features noted were presence of dysplasia, focus of adenoma, or malignancy. RESULTS: The prevalence of gastric polyps was 434 (4%) of 10,800 upper gastrointestinal endoscopies. Majority of polyps were found in the last 4 years (277: 63.8%). Mean age was 55.4 years with male to female ratio 1:1.2. Most of the polyps (94.9%) were less than 1 cm, located in gastric antrum. Multiple polyps were seen in 20.9% cases. On histopathology, fundic gland polyps were most common (147: 33.8%), followed by hyperplastic (128: 29.4%) polyps. Adenomatous polyps were nine (2%); of these, two cases of hyperplastic polyps and one each of fundic gland polyp and benign epithelial polyp showed adenomatous foci. CONCLUSION: Fundic gland polyps were the most common polyps. With rising incidence of gastric carcinoma, identification of gastric polyps on endoscopy with biopsy can prevent progression to carcinogenesis.

Milan System for Reporting Salivary Gland Cytopathology- An Experience from Western Indian Population.

INTRODUCTION: Fine-needle aspiration cytology (FNAC) can be challenging to provide a precise diagnosis in salivary gland cytopathology due to diversity of lesions and cytomorphological convergence between the tumors and within the same tumor of salivary gland. The recently proposed Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a risk stratification-based classification system with an intrinsic risk of malignancy (ROM) for each diagnostic category, which aims to furnish useful information to the clinicians. This study was undertaken to evaluate the diagnostic utility and validity of MSRSGC. METHODS AND MATERIAL: In this retrospective study, FNAC done for all salivary gland lesions over a period of two years were retrieved. All cases were categorized according to MSRSGC and correlated with histopathological follow-up, wherever available. ROM was calculated for each category. RESULTS: The cases belong to following categories: non-diagnostic (1.27%), non-neoplastic (30.38%), atypia of undetermined significance (5.06%), benign neoplasm (46.84%), salivary gland neoplasm of uncertain malignant potential (1.27%), suspicious for malignancy (1.27%), and malignant (13.92%). Out of 79 cases, 50.63% had follow-up. The ROM were 0% for category II and IVa, 50% for category III, and 100% for category IVb, V, and VI. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were recorded as 77.78%, 100%, 100%, 91.3%, and 93.33%, respectively. CONCLUSIONS: Application of MSRSGC has immense value for standardization of reporting of salivary gland FNAC. Our data corresponds to the studies done worldwide and recommends the use of MSRSGC for future diagnostic purposes.

Occult medullary carcinoma of thyroid with lymph node metastases: a case report.

BACKGROUND: Occult thyroid malignancies presenting with secondary neck masses as the first clinical manifestation is well known. Although rare, medullary carcinoma serves a potential source for lymph node metastases. The characteristic cytomorphology of medullary thyroid carcinoma (MTC) should clinch the diagnosis. Further, fine needle aspiration cytology (FNAC) of the ultrasonography-detected occult nodules in thyroid serves as a useful preoperative diagnostic tool. CASE: A 22-year-old man presented with left-sided neck masses of 1 year duration. FNAC smears of the neck masses revealed cytomorphology characteristic of MTC. Ultrasonography of the thyroid led to ruling out the presence of an occult nodule and detected an 8-mm nodule in the left thyroid lobe. Ultrasound-guided FNAC of the nodule showed features similar to those with FNAC of the neck masses. Surgical resection of thyroid and neck masses further confirmed the diagnosis of a primary occult MTC with lymph node metastases. CONCLUSION: FNAC smears of lymph node masses showing the distinct cytomorphology of MTC should prompt suspicion for occult primary in thyroid. Ultrasound-guided FNAC of these occult nodules, if detected, further serves a diagnostic tool for accurate preoperative diagnosis when metastasis presents as the first clinical manifestation of an occult primary.

Metastasis of breast lobular carcinoma in a cervical leiomyoma.

We report here a case of 40-year-old female admitted in view of bilateral ovarian tumors. There was past history of modified radical mastectomy. CT scan revealed a uterine cervicalfibroid in addition to bilateral adnexal masses. Lobular carcinoma metastasis were seen in the leiomyoma as well as in the bilateral ovaries. Metastasis of ductal carcinoma to uterine leiomyoma have been reported in literature. The present case is unique in two ways--(1) metastasis of lobular carcinoma (2) occurring in a cervical leiomyoma.

Anaplastic large cell lymphoma: A great mimic on cytology.

Anaplastic large cell lymphoma (ALCL) is a T-cell lymphoma, accounting for <5% of non-Hodgkin's lymphoma. Cutaneous involvement can be primary or secondary arising in systemic ALCL. The diagnostic feature in both is the presence of pleomorphic, CD30 positive hallmark cells. We present a case of ALCL in a 19-year-old male presenting as an ulcerated scalp swelling. Clinical impression was actinomycosis or scrofuloderma. Cytology smears showed large dispersed pleomorphic cells with hyperlobated nuclei and multinucleated giant cells. The differentials considered were ALCL, rhabdomyosarcoma, and poorly differentiated carcinoma. Immunocytochemistry (ICC) showed positivity for leukocyte common antigen (LCA) and CD30 while negativity for desmin, favoring ALCL. Computed tomography (CT) showed a lytic paravertebral lesion. Subsequently, both paraspinal and scalp lesions were biopsied and immunochemistry confirmed the diagnosis of ALCL. Thus, cutaneous involvement in ALCL can resemble inflammatory and other neoplastic lesions clinically and cytologically. Hence, a high index of suspicion and ICC can aid in the correct diagnosis on fine needle aspiration cytology (FNAC).

Evaluation of thyroid nodules classified as Bethesda category III on FNAC.

BACKGROUND: The Bethesda (BSRTC) category III has been ascribed a malignancy rate of 5-15%, however, the probability of malignancy remains variable. AIM: To evaluate category III with respect to its rate and risk of malignancy and substratify it. SETTINGS AND DESIGN: Atypia of undetermined significance/Follicular lesion of undetermined significance (AUS/FLUS) percentage, cytohistological correlation, and risk of malignancy were analyzed and substratification was done. MATERIAL AND METHODS: Category III cases over a 2-year period were analyzed retrospectively. STATISTICAL ANALYSIS: Two-tailed Fisher exact test, with a level of significance set at 0.05, was performed for data analysis. RESULTS: Of 1169 thyroid fine needle aspirations (FNAs), 76 (6.5%) were category III. A total of 48 patients had follow up; 24 patients underwent surgery, 12 repeat FNA, and 12 were clinically followed. Repeat FNA cytology was unsatisfactory in 8.3%, benign in 66.7%, AUS in 8.3%, and follicular neoplasm in 16.7%. Of the 24 operated, 8 (33.3%) were malignant (follicular variants of papillary thyroid carcinoma), 5 (20.8%) were follicular adenomas, and 11 (45.8%) were non-neoplastic. Among all AUS/FLUS nodules with follow-up, malignancy was confirmed in 16.7% (8/48) whereas with nodules triaged to surgery only, the malignancy rate was 33.3% (8/24). Substratification into categories of "cannot exclude PTC" and "favor benign" helped detect malignancy better, as 85.7% cases in the first subcategory (P < 0.001) and none (P < 0.02) in the last proved malignant. CONCLUSION: Though the rate of Category III in our study is in accordance to BSRTC, the risk of malignancy in AUS/FLUS nodules is higher. Substratification of AUS/FLUS may help better patient management.

Amyloid goiter: cytomorphological features and differential diagnosis on fine needle aspiration cytology: a case report.

BACKGROUND: Amyloid goiter is a rare cause of thyroid enlargement which can be confused clinically as well as cytologically with both colloid goiter and neoplastic process of thyroid. CASE: A 30-year-old man, diagnosed with chronic kidney disease 5 months previously and currently on dialysis and awaiting renal transplant, was referred by clinicians for fine needle aspiration cytology (FNAC) for thyroid swelling. FNAC showed dense amorphous clumps of extracellular material which appeared magenta colored on Giemsa and eosinophilic on Papanicolaou stain. Congo red staining and polarization showed characteristic apple green birefringence, thus confirming the material as amyloid, and the diagnosis of amyloid goiter was made. CONCLUSION: Amyloid on FNAC smears can be easily mistaken for colloid, and correct interpretation can avoid a false diagnosis of colloid goiter. A search should be made to look for any features suggestive of medullary carcinoma of the thyroid as amyloid is more often associated with it.