Cyto-histological correlation in diagnosis of gastrointestinal lesions- a prospective study in a tertiary care institute

Background: Gastrointestinal tract is involved by a large number of inflammatory, infectious and neoplastic diseases. There is a worldwide rising incidence of GIT lesions especially neoplasms.Methods: This study was planned to correlate endoscopic and colonoscopic brush cytology with histopathology of gastrointestinal lesions and to determine the spectrum of gastrointestinal lesions in patients subjected to endoscopic brushings and biopsy.Results: Sensitivity of upper GI brush cytology was 95.15% and specificity 90.41%. Sensitivity of colonoscopic brush cytology was 100% and specificity 86.79%. The accuracy of brush cytology came out to be 92.45% in upper GIT and 92.22% in lower GIT.Conclusions: Brush cytology is a non-invasive and cost-effective method to retrieve epithelial cells from a much larger surface area of the mucosa, thus allowing thorough sampling and increasing the diagnostic yield.

The Bethesda system for reporting thyroid cytology: a prospective study in a tertiary care institute along with review of literature

Background: The Bethesda system for reporting thyroid cytology (TSBRTC) was devised by the National Cancer Institute (NCI) to obtain uniformity, reproducibility and a defined management protocol while dealing with thyroid lesions. This study was undertaken with the aim to see the benefits of adopting TBSRTC in the diagnosis of thyroid FNAC, and identify the malignancy risk of each category.Methods: This cross-sectional study was conducted in Indira Gandhi Medical College, Shimla, Himachal Pradesh from June 2016 to July 2017 on 181 thyroid FNACs which were reported according to the Bethesda system for reporting thyroid cytopathology (TBSRTC) under six categories: (I) non-diagnostic/unsatisfactory (II) benign (III) atypia of undetermined significance/follicular lesion of undetermined significance (IV) follicular neoplasm/suspicious for follicular neoplasm (specify if Hurthle cell (oncocytic) type (V) suspicious for malignancy (VI) malignant. Histopathological diagnosis was available for 65 cases where thyroidectomy was performed. Malignancy risk was calculated for each category. Sensitivity, specificity, positive and negative predictive values for TBSRCT were also calculated. All the data was analyzed in SPSS software version 22.0 (IBM, USA).Results: Benign lesions constituted the major bulk. After the use of TBSRTC, there was increased ability to look for follicular neoplasms, improvement in making definitive diagnosis of the cases, an improvement in diagnostic accuracy, and we were in line with the implied risk outlined by TBSRTC in most of the cases.Conclusions: Application of TBSRTC results in uniformity in reporting among pathologists and better interdisciplinary communication and patient management.

Primary pleomorphic liposarcoma of breast: A rare case report.

Sarcoma of the breast constitutes less than 1% of all malignant breast tumors and liposarcoma of the breast has an incidence of 0.3% of all the mammary sarcomas. A 47-year-old woman presented with a mass in the right breast and mammography was suggestive of a malignant lesion. Modified radical mastectomy was performed. The tumor was diagnosed histologically as a pleomorphic liposarcoma. The patient was discharged and her postoperative recovery was uneventful.

Cutaneous sporotrichosis: Unusual clinical presentations.

Three unusual clinical forms of sporotrichosis described in this paper will be a primer for the clinicians for an early diagnosis and treatment, especially in its unusual presentations. Case 1, a 52-year-old man, developed sporotrichosis over pre-existing facial nodulo-ulcerative basal cell carcinoma of seven-year duration, due to its contamination perhaps from topical herbal pastes and lymphocutaneous sporotrichosis over right hand/forearm from facial lesion/herbal paste. Case 2, a 25-year-old woman, presented with disseminated systemic-cutaneous, osteoarticular and possibly pleural (effusion) sporotrichosis. There was no laboratory evidence of tuberculosis and treatment with anti-tuberculosis drugs (ATT) did not benefit. Both these cases were diagnosed by histopathology/culture of S. schenckii from tissue specimens. Case 3, a 20-year-old girl, had multiple intensely pruritic, nodular lesions over/around left knee of two-year duration. She was diagnosed clinically as a case of prurigo nodularis and histologically as cutaneous tuberculosis, albeit, other laboratory investigations and treatment with ATT did not support the diagnosis. All the three patients responded well to saturated solution of potassium iodide (SSKI) therapy. A high clinical suspicion is important in early diagnosis and treatment to prevent chronicity and morbidity in these patients. SSKI is fairly safe and effective when itraconazole is not affordable/ available.

Matrix-producing mammary carcinoma: a rare breast tumor.

Matrix-producing carcinoma of the breast is a unique subclass of metaplastic carcinoma which is characterized by the existence of a ductal carcinomatous component with direct transition to areas showing cartilagenous or osseous differentiation, lacking an interspersed spindle cell component. This article reports one such rare case in a 50-year-old woman who had a right breast mass. f0 ine needle aspiration (FNA) smears showed abundant chondromyxoid extracellular matrix to which were variably admixed carcinomatous cells. Histological examination revealed a neoplasm composed of invave ductal carcinoma with a direct transition to chondrosarcomatous areas. The case is reported not only for its peculiar microscopic characteristics but also to highlight its better prognostic features and hence, the need for its recognition.

A rare case of secretory breast carcinoma in an elderly woman: correlation of aspiration cytology and histology.

Secretory carcinoma (SC) of the breast is an extremely rare neoplasm, often associated with a very good prognosis. It is still rarer in adults, where it is potentially more aggressive than in childhood. The present case refers to a 52 year old female with a progressively growing lump in the right breast. The cytological and histopathological findings were characteristic of secretory carcinoma. The differential diagnoses are discussed and the pertinent literature is reviewed.

Mucoepidermoid carcinoma arising in Warthin's tumor: a case report.

Malignant transformation of the epithelial component of Warthin's tumor is extremely rare. We describe our experience of mucoepidermoid carcinoma arising in Warthin's tumor of the parotid gland in a 35 year old female. The tumor removed from the parotid region was well encapsulated and histologically comprised ofmucoepidermoid carcinoma along with areas of Warthin's tumor. The pathogenesis and differential diagnosis of this rare occurrence have been discussed.

Fine needle aspiration cytology of breast carcinoma with neuroendocrine features--a case report with histopathological and immunohistochemical correlation.

Cytohistological and immunohistochemical features of a rare case of breast carcinoma with diffuse neuroendocrine features occurring in an elderly female patient is reported. Cytology demonstrated predominantly single and loose clusters of monomorphic plasmacytoid tumor cells that possessed moderate amounts of basophilic cytoplasm with eccentrically placed nuclei. These cells were also showing conspicuos rosette like formations. Histological examination showed a typical endocrine pattern with organoid nests and ribbons of well differentiated monomorphic cells with frequent pseudorosette formation resembling carcinoid tumor of gastrointestinal tract. Neuroendocrine differentiation was confirmed by immunohistochemical positivity for neuron specific enolase, synaptophysin and chromagranin.

Mucinous cystadenoma of the renal pelvis with malignant transformation: a case report.

A mucinous cystadenoma of the renal pelvis with malignant transformation is an extremely rare entity. We discuss one such rare occurrence in a 62 year old female who developed mucinous nephrosis due to marked retention of mucin produced by the tumor.

Focal eosinophilic myositis--a rare cause of pseudotumor.

Idiopathic focal eosinophilic myositis is a rare benign pseudotumor of skeletal muscle of unknown cause, characterized by focal eosinophilic infiltration of striated muscle. It can mimic a soft tissue sarcoma clinically and on gross examination of the specimen. Microscopic examination establishes the diagnosis. It is important to recognize this pseudosarcomatous lesion so as to spare the patient from anxiety.

Calcifying fibrous pseudotumor of the soft palate--a case report.

Calcifying fibrous pseudotumor has recently been described in the soft tissues. It is a rare benign lesion characterized by the presence of abundant hyalinized collagen with psammomatous or dystrophic calcification, and lymphoplasmacytic infiltrate. We report one such rare case in an 18 year old female with a nodular mass in the soft palate treated by complete resection. The mass had all the pathologic features of a calcifying fibrous pseudo-tumor.

Invasive lobular carcinoma of male breast--a case report.

A 56 year old male presented with painless subareolar lump in the left breast was subsequently diagnosed as invasive lobular carcinoma. This case is reported in view of its rarity.

Apocrine carcinoma of the breast presenting as a solitary cyst: cytological and histopathological study of a case.

Apocrine carcinoma is a rare, unique and morphologically distinct type of invasive breast carcinoma. This tumor has predilection for elderly females (6th and 7th decade). This report is of apocrine carcinoma of the breast arising in a 27 year old female, a rare occurrence in this age group, with only a few cases on record.

True malignant mixed tumor (carcinosarcoma) of parotid gland : a case report.

The malignant mixed tumor (carcinosarcoma) of the salivary gland is an extremely rare tumor. By definition, it is composed of both malignant epithelial and malignant mesenchymal components. We report a case of carcinosarcoma in the parotid gland of a 59 year old man, that arose "de novo" and contained ductal adenocarcinoma as the epithelial component and osteosarcoma and chondrosarcoma as mesenchymal components. The etiologic and histologic features are presented and in addition, the literature is reviewed.