Efficacy of bronchial wash cytology and its correlation with biopsy in lung tumours

Objective: To evaluate bronchial wash cytology with histology in our set up

Material and Methods: Seventy three specimens were obtained by flexible fiberoptic bronchoscope at pulmonology department of Military Hospital Rawalpindi. All the preserved samples were processed under standard conditions. The slides were stained with Papanicolaou and Haematoxylin and Eosin stains

Results: A total of 73 patients were studied. The age range was 21 to 80 years . Male to female ratio was 8:1. Complete cytological and biopsy consensus was found in 55 [77.4%] cases. Cytology revealed 24 cases as malignant and nine as atypical/suspicious. Benign and inadequate were 29 and 2 respectively. Histopathology of these cases confirmed 24 [32.9%] as malignant and 29 [39.8%] as benign. True positive alongwith suspicious/atypical were 33 and true negative cases were 29. False positive was one case only whereas false negative cases were eight. The bronchial wash cytology showed sensitivity [80.5%], specificity [96.6%] and accuracy [87.3%]. Positive predictive value and negative predictive value were 97% and 78.4% respectively. The commonest types of tumours were squamous cell carcinoma and small cell carcinoma

Conclusion: It is concluded that bronchial wash cytology is a valuable tool and yields almost same information as biopsy. It is useful in patients with evidence of obstruction or risk of haemorrhage

Is there a correlation between degree of viremia and liver histology in chronic hepatitis C?

To determine the correlation between degree of histological liver damage and serum HCV RNA level in patients of chronic hepatitis C, in order to evaluate the usefulness of HCV RNA estimation as an alternate to liver biopsy. This non-interventional descriptive study, was carried out at the department of Pathology, Army Medical College, Rawalpindi, Pakistan between April and September 2002. Core needle liver biopsies of fifty five patients of chronic hepatitis C were evaluated according to Knodell's histological activity index system. The patients were categorized into four subgroups depending upon the grade and stage of disease according to Desmet's classification, and into three groups according to degree of viremia. Five patients had mild viremia, 43 moderate and 7 had severe viremia. Seven patients had minimal disease, 9 mild, 22 moderate and 17 had severe chronic hepatitis. Eight patients had no fibrosis, 20 had fibrous portal expansion, 19 bridging fibrosis, and 8 patients had cirrhosis. No significant correlation was found between serum HCV RNA levels and grade or stage of the disease, with correlation coefficients of rs = -.054 and rs =.034 respectively. Moreover, no individual component of the HAI correlated with serum HCV RNA levels. Serum HCV RNA level does not determine the degree of hepatic injury precisely and liver biopsy is necessary to accurately evaluate the extent of liver damage

autopsy study of hypertrophic cardiomyopathy

To see the pathological features of this disease in our set up and to emphasise the importance of morphological examination in making the diagnosis of hypertrophic cardiomyopathy [HCM] especially in cases of sudden cardiac death. A retrospective, descriptive study of 15 autopsies of this particular disease was carried out at the Armed Forces Institute of Pathology [AFI] Rawalpindi during the period from 1990 to 1995.The hearts along with blood vessels were fixed in 10% formalin and were dissected according to the modified Virchow's method for eliciting the gross appearance of cardiac chambers and valves. Representative sections were taken for histological examination. All the cases were young adult males. The age range was from 17-34 years [mean, 26-6 years] Ten cases died suddenly and five cases had an evidence of moderate to severe exertion preceding their death. Symmetrical as well as asymmetrical hypertrophy was noted in this study. The thickness of inter ventricular septum [mean 20 mm] and left ventricular wall [mean 22.5 mm] was increased. All the specimens revealed disarray of hypertrophic myocardial fibres and patchy interstitial fibroses. Sudden death is usually the first manifestation of disease. The hearts showed asymmetric as well as concentric hypertrophy. Myofibre hypertrophy and disarray was an important pathological findings in our cases. While carrying out post-mortem examination of a case of sudden cardiac death one should also keep in mind the possibility of this disease

Histological interpretation of transbronchial biopsies

A clincopathological study of 100 consecutive transbronchial biopsies is presented. These biopsies were taken from 82 males and 18 females. The age of the patients varied from 16 years to 85 year. Fifty eight patients were clinically suspected to be suffering from carcinoma lung, whereas tuberculosis was provisional diagnosis in 15 patients, the differential diagnosis included both tuberculosis and malignancy. The histology revealed malignancy in 44 patients, whereas tuberculosis was diagnosed in only 6 patients. Acute on chronic non-specific inflammation was present in 32 biopsies. The sampling was adequate in almost all the cases except 5 biopsies which were insufficient for an opinion. In cases of malignancies the positive tissue diagnosis was 61%, but in cases of suspected pulmonary tuberculosis the histological diagnosis was only 20%. These findings suggest that transbronchial biopsy is a fairly reliable method for diagnosis of carcinomalung, whereas for diagnosis of pulmonary tuberculosis, bacteriological studies should supplement the transbronchial biopsies