Diagnostic accuracy of fine needle aspiration cytology: comparison of results in Tabriz Imam Khomeini Hospital and Shiraz University of Medical Sciences

It is more than 60 years that Fine Needle Aspiration [FNA] has been used for diagnosing palpable breast masses and has been known as an effective method for several years in Europe. In this study, we compared the diagnostic accuracy of FNA with open biopsy in Tabriz and Shiraz, Iran. We studied 100 patients with breast lesions in Tabriz Imam Khomeini Hospital from late September 2003 to late July 2004. FNA and open biopsy were done for all patients, FNA results were studied by pathologists in Tabriz imam Khomeini hospital and Shiraz University and pathological and cytological results were compared. According to cytology, 44% of samples were benign, 15% were suspicious, 33% were malignant and 8% were insufficient in Tabriz. These figures were 25%, 10%, 27% and 37%, respectively in Shiraz. Sensitivity of FNA was higher in Tabriz [89.79% vs. 69%] but specificity did not differ significantly in two groups [93.47% vs. 80.95%]. Positive and negative predictive values were 97.77% and 89.36% in Tabriz and 100% and 60.6% in Shiraz, respectively. FNA accuracy was higher in Tabriz than in Shiraz [93.47% vs. 80.95%]. If done by experts, FNA can be a reliable replacement for open biopsy in palpable breast masses. Evaluation of FNA samples during aspiration can decrease insufficient samples. FNA [at least in deprived areas] can be the first line of diagnosis in women with breast masses and is helpful to increase health standards and clinical supervision of patients

Breast metastatic alveolar rhabdomyosarcoma: FNA findings

A 25-year-old woman, a known case of vulvar rhabdomyosarcoma presented with bilateral breast nodules. Fine needle aspiration was performed. The smears revealed numerous round malignant cells, positive for malignancy. Histopathologic and immunocytochemical examination confirmed the diagnosis of metastatic alveolar rhabdomyosarcoma. The cytological findings of alveolar rhabdomyosarcoma of the breast are rarely reported. The clinical history and immunocytochemical study contributed to the diagnosis of metastatic alveolar rhabdomyosarcoma

relationship between blood group type and visceral leishmaniasis in Iran

Visceral leishmaniasis [VL] or Kala-azar is still a common parasitic infection among children in Iran. This study was performed to investigate the relationship between blood group type and VL among Iranian patients. were enrolled. The bone marrow materials of 249 children who were clinically suspected for VL were provided from the posterior iliac spine by Jamshidi`s needle. LD bodies were identified in all cases and diagnosed as VL. The distribution of blood group type of all infected patients was compared with that of a control group of normal donors [2490]. There were 198 males and 51 females among VL patients. In both the VL and control groups, the maximum percentage was found in blood group O and minimum in blood group AB. Our results showed that the blood group was not a risk factor in the occurrence of VL. The ABO-Rh blood groups were not associated with the occurrence of VL in Iranian patients

Fine needle aspiration cytology of intraocular, orbital and eyelid lesions

Fine-Needle Aspiration Cytology [FNAC] is used for diagnosis of intraocular, orbital and eyelid lesions. In this study we evaluated the outcome and the accuracy of using this technique in diagnosis of benign or malignant behavior of lesions. FNAC was performed on 26 specimens obtained from 25 patients with intraocular, orbital and eyelid tumors and the results were compared with the histopathologic findings in a prospective double-blind observational study. In 22 specimens [85%] a concordant definitive diagnosis was established that comprised five retinoblastoma, four basal cell carcinomas, four inflammations and two dermoid cysts. All specimens were diagnosed as benign or malignant with reasonable concordance. Definitive cytologic diagnosis was also made in two rare, if ever reported, conditions namely orbital fibrous histiocytoma and eyelid leishmaniasis. FNAC seems to be a simple, rapid, relatively safe and cost-effective technique with considerable diagnostic value in the assessment of selected ophthalmic lesions, especially when sampling and interpretation are performed by experienced personnel

Value of fine needle aspiration in diagnosing abdominal and retroperitoneal masses of children

The aim of this study was to evaluate the role of fine needle aspiration cytology in the diagnosis of abdominal and retroperitoneal masses in children on this study. In 53 cases of childhood abdominal and retropertioneal massess within a 4 year period [1998-2001] preoperative finer needle aspiration was done under the guide of CT scan. 2 pathologists reviewed fine needle aspiration smears. In all of the cases the gold standard for diagnosis was the tissue specimen, which showed 37 malignant, 2 benign neoplastic and 12 nonneoplastic diseases. This study showed that the sensitivity and specificity of fine needle aspiration cytology for the diagnosis of malignancy and benignity [positive or negative for malignancy] is 97.2% and 81.2% respectively. It was 100% accurate for the diagnosis of cell type in neuroblastoma-ganglioneuroblastoma, hepatoblastoma and Wilm's tumor, 77% accurate for lymphoma and 57% for germ cell tumors. There was no complication in any of the cases after fine needle aspiration. So fine needle aspiration is a reliable and sensitive method for the preoperative diagnosis of malignant pediatric abdominal and retroperitoneal masses and we recommend doing FNA cytology as a routine method for the diagnosis of such cases

Primary cardiac lymphoma

A 4-year-old boy referred to our clinic with fever, abdominal pain and vomiting. He had a muffled heart sound and increased Jugular venous pressure on physical examination and cardiomegally on the chest X-ray. Echocardiography showed a mass in the right ventricular outflow tract. A biopsy from the mass revealed primary cardiac lymphoma. He did not respond to chemotherapy and died

Primary pericardial thymoma in a child: case report

We report on a primary pericardial thymoma in a 9-year-old child, presenting with shortness of breath, and finally, cardiac tamponade. With a cardiopulmonary bypass, the mass was resected via a median sternotomy

Ano-rectal anomaly associated with Hirschsprung's disease

Two hundred and eighty-one patients with ano-rectal malformation [ARM] were treated between September 1983 and August 1994. The criteria for consideration of the patient as a probable case of Hirschsprung's disease [HD] in the absence of anal stenosis were: 1] constipation unresponsive to medical therapy; 2] anastomotic leakage following closure of colostomy after ano-rectoplasty. Posterior ano-rectal myectomy [PARM] was carried out as a diagnostic step. If the patient was still symptomatic and the myectomy specimens showed histologic signs of HD, a definitive procedure was performed. Eighteen patients [6.4%] proved to have HD. No instance of HD was observed in high type malformations [28 patients] and cloacal anomalies [3]. However, 13 of 123 patients with low ARM [10.5%] and 5 of 127 patients with intermediate anomalies [3.93%] had HD [P< 0.05]. FARM was therapeutic in the 5 patients with ultrashort HD, all of whom had low ARM. The remaining 13 patients [8 low, 5 intermediate] had to undergo a definitive procedure. In conclusion: 1. association of HD with ARM, especially low types, is not uncommon. 2. biopsy of the rectal wall is recommended at the time of correction of low and intermediate ARM. 3. PARM may be therapeutic in HD, especially if associated with low type anomalies

Benign hemophagocytic syndrome associated with kala-azar

Relapse of Kala-Azar in thirteen patients showed association with benign hemophagocytic syndrome characterized by diffuse infiltration of hemophagocytic cells and numerous Leishman bodies in the bone marrow. The hemophagocytic cells which are large with abundant cytoplasm were seen to engulf various types of mature and immature blood cells. The follow-up revealed serious complications; blindness in one patient, post kala-Azar dermal leishmaniasis in two patients and two patients died. The rest of the eight patients were doing well after multi-drug therapy which included glucantime and amphotericin B. Immune deficiency might play a role in the pathogenesis of this syndrome

Ocular leishmaniasis: a cause of blindness

Leishmaniasis involving the eye and causing blindness is rare. Three cases of blindness caused by leishmaniasis are described in this report; two were caused by the direct extension of conjunctival leishmaniasis and one was caused by the systemic dissemination of kala-azar. Histologic sections of the enucleated eye balls showed multiple non-caseating granulomas in the bulbar conjunctiva, iris, ciliary body and retina. At higher magnification these granulomas revealed leishman bodies. This blindness can be prevented by early diagnosis and prompt vigorous treatment with glucantime

Primary papillary adenocarcinoma of the renal pelvis in a young boy

A rare case of primary adenocarcinoma of the renal pelvis in an adolescent boy is reported. Clinicopathological findings are discussed and the available relevant literature is briefly reviewed

Cutaneous T-cell lymphoma: a peculiar presentation and review of the literature

The clinical and histological findings of cutaneous T-cell lymphoma have been described here. Clinically it was first confused with noma, mucocutaneous leishmaniasis, leprosy, midline lethal granuloma, rhinoscleroma or localized form of Wegener's granulomatosis because of its location on the face

Medical and surgical management of intestinal malacoplakia

During the last 7 years diagnosis of intestinal malacoplakia [MP] has been confirmed in 5 children and one adult, either by colonoscopy with tissue biopsy or fine needle aspiration [FNA]. All children had chronic abdominal pain, bloody diarrhea, low grade fever and irregular abdominal mass with signs of partial intestinal obstruction. The adult patient had the same symptoms with no mass. Complete resection was possible in only one child with no evidence of recurrence. The adult patient developed recurrence in the ileum and rectum 2 years after total colectomy and ileo-proctostomy. Four patients had unresectable tumors, all of whom also had hydronephrosis. Of these patients who were all handled by ileo-sigmoidostomy as a bypass, ileostomy or right transverse colostomy, 2 died 1-3 months later. In the presence of abdominal mass, diagnosis is feasible by FNA. However, colonoscopy is mandatory for appropriate decision and management. Intestinal MP should be managed seriously because of its aggressive nature. If diagnosed early, MP may be cured by medical therapy alone or by resection with or without adjuvant medical therapy. An underlying immunosuppressive disorder should also be looked for

Melanotic neuroectodermal tumor of infancy - a case report

Melanotic neuroectodermal tumor is seen in an infant. Histologically the tumor is composed of alveolar-like spaces in a dense fibrous stroma. These spaces are lined by melanin-containing cuboidal cells and the lumen contains neuroglial-like cells. Ultrastructural studies suggest that the neoplasm is of the neural crest origin. The first case in Iran is reported

Adamantinoma of tibia: a case report

Adamantinoma is a rare primary malignant tumor of the long bones with unknown pathogenesis. So far only a few cases are reported in the literature [2,3,9,11,17]. Tibia is the major site of predilection, however, the tumor also reported occasionally in other long bones such as femur, fibula, humerus, ulna and radius [1,8,12]. Most of the patients are in the second and third decades of life. Rarely fibrous dysplasia [5] is associated with adamantinoma of the long bones. The symptoms are long standing. The routine radiologic finding is that of multiple lucent zones interspersed with sclerotic bone,usually with one large rarefied area in the mid shaft.Histologically, islands of epithelial cells with peripheral palisading are seen in fibrous stroma. Histogenesis of this tumor is not yet clear. But majority of the believe that of epithelial origin [6,15,16,18].Treatment depends upon the extent of tumor. If it is surgic feasible, resection of the tumor is the treatment choicet if not, amputation. Here we report one case of adamantinoma of tibia and discuss clinicopathological findings